Journal Of Electrocardiology[JOURNAL]
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200 papers
Systematic multi-domain screening of lead-specific electrocardiographic features associated with sudden cardiac death.
Kivimäki K, Rankinen J, Järvensivu-Koivunen M … +5 more , Pohjantähti H, Lyytikäinen LP, Nikus K, Tynkkynen J, Hernesniemi J
J Electrocardiol · 2026 Jul · PMID 42401136 · Publisher ↗
UNLABELLED: Electrocardiogram (ECG) provides four-dimensional view to the electrical properties of the heart. We performed a comprehensive multi-domain screening to find the most significant lead-specific ECG features as...
UNLABELLED: Electrocardiogram (ECG) provides four-dimensional view to the electrical properties of the heart. We performed a comprehensive multi-domain screening to find the most significant lead-specific ECG features associated with sudden cardiac death (SCD). METHODS: We analyzed retrospective data from 21,176 consecutive patients undergoing coronary angiography in Tampere University Hospital between 2007 and 2018. 937 ECG variables provided by the 12SL algorithm were used for the analysis. From those, the significant lead-specific ECG variables were categorized into three subgroups: P-wave, QRS complex, and ST-segment/T-wave. The most significant (i.e., lowest P-value) independent lead-specific ECG variables were tested in multivariate analysis after filtering correlating variables with weaker associations with SCD. RESULTS: Among ventricular depolarization (QRS complex) variables, the strongest associations with SCD were observed for QRS intrinsicoid deflection (lead I) (p = 4.6 × 10), QRS peak-to-peak amplitude (lead aVR) (p = 1.9 × 10), and Q-wave amplitude (lead V1) (p = 7.6 × 10). Among repolarization (ST-segment and T-wave) variables, the strongest predictors of SCD were T-wave amplitude (lead aVR) (p = 3.5 × 10) and ST-segment end amplitude (lead aVL) (p = 8.1 × 10). The strongest associations with SCD among atrial depolarization (P-wave) variables were P-wave onset amplitude (lead V6) (p = 3.1 × 10), P'-wave amplitude (lead V2) (p = 2.1 × 10), and P-wave duration (lead V2) (p = 2.4 × 10). These variables remained significant in multivariate analysis alongside global ECG variables (e.g., heart rate, QRS duration, and LVH). CONCLUSION: Systematic screening and utilizing the full prognostic potential of the 12‑lead ECG reveal several key elements of the electrical properties of the heart that associate with SCD.
The need to measure electrical synchrony - Assessment of electrical synchrony and its utility. Synchromax in real life.
Ortega DF, Paolucci AG, Logarzo EA
J Electrocardiol · 2026 Jun · PMID 42398300 · Publisher ↗
Electrical synchrony is a key determinant of cardiac function and a fundamental component in the success of cardiac resynchronization therapy (CRT). Despite its importance, its definition remains imprecise and its assess...
Electrical synchrony is a key determinant of cardiac function and a fundamental component in the success of cardiac resynchronization therapy (CRT). Despite its importance, its definition remains imprecise and its assessment is largely based on indirect and non-standardized electrocardiographic parameters, such as QRS duration and morphology, which do not consistently reflect true electrical dyssynchrony or predict response to therapy. This narrative review explores the current understanding of cardiac electrical synchrony, highlighting the limitations of conventional evaluation methods and the heterogeneity of results observed in different clinical scenarios, including conduction disorders, heart failure, and device-based therapies. Special emphasis is placed on Synchromax®, a novel non-invasive tool that enables real-time assessment of electrical synchrony through cross-correlation analysis of surface electrocardiographic leads. This method provides reproducible, operator-independent measurements and allows classification of patients into different synchrony patterns. Clinical applicability spans pre-implant evaluation, intra-procedural guidance for optimal lead positioning, and post-implant optimization of pacing strategies. Furthermore, it offers new insights into the pathophysiology of conduction disturbances and supports the ongoing shift toward physiological pacing approaches. The ability to objectively measure electrical synchrony may represent a paradigm shift in cardiac electrophysiology, improving patient selection, guiding therapeutic decisions, and potentially reducing the rate of non-response to CRT. Integrating new tools for synchrony assessment into clinical practice could contribute to a more individualized and effective approach to cardiac pacing and resynchronization.
An assessment of intern doctors' experiences of undergraduate education in electrocardiogram interpretation.
Maher L, O'Tuathaigh C, Mahon C
J Electrocardiol · 2026 Jun · PMID 42398299 · Publisher ↗
AIM: The aim of this study is to assess the adequacy of undergraduate ECG education from the perspective of recent medical graduates. METHODS AND METHODOLOGY: A mixed-methods survey was administered to intern doctors in...
AIM: The aim of this study is to assess the adequacy of undergraduate ECG education from the perspective of recent medical graduates. METHODS AND METHODOLOGY: A mixed-methods survey was administered to intern doctors in a large Irish university hospital. A de novo survey was developed using established survey design principles and items adapted from validated educational tools and prior ECG education literature. It included Likert-scale items assessing perceptions of undergraduate ECG education, self-rated confidence across seven common ECG patterns, and open-ended questions exploring experiences, barriers, and recommendations. Quantitative data were analysed descriptively, while qualitative responses underwent thematic analysis using the Braun and Clarke framework. RESULTS: 72 intern doctors participated. Quantitative findings showed variability in perceptions of ECG education quality. Educators were regarded as knowledgeable, but opportunities for active engagement, practice on authentic ECGs, and constructive feedback were limited. Confidence in interpreting common ECG patterns was moderate, with preparedness for clinical practice perceived as inconsistent. Qualitative findings reinforced these results, with participants describing ECG teaching as infrequent, inconsistently delivered, and often disconnected from clinical realities. Stress, low confidence, and limited access to feedback were frequently cited barriers to effective learning. CONCLUSION: Although intern doctors value ECG interpretation as a core clinical skill, they feel underprepared by undergraduate teaching. Gaps are evident in the quantity and consistency of instruction, the availability of practice opportunities, and the provision of timely, constructive feedback. Participants expressed a strong preference for small-group, interactive sessions using real-world ECGs with structured feedback, highlighting clear priorities for curricular reform.
Feasibility and efficacy of left bundle branch area pacing guided by modified chest lead 1.
Wakasa S, Yoshiyama T, Hirayama S … +4 more , Fukuda K, Yanagishita T, Hayashi Y, Fukuda D
J Electrocardiol · 2026 Jun · PMID 42391834 · Publisher ↗
BACKGROUND: Left bundle branch area pacing (LBBAP) typically requires 12‑lead electrocardiogram (ECG) measurements using an electrophysiology (EP) recording system. However, a simplified approach using modified chest lea...
BACKGROUND: Left bundle branch area pacing (LBBAP) typically requires 12‑lead electrocardiogram (ECG) measurements using an electrophysiology (EP) recording system. However, a simplified approach using modified chest lead 1 (MCL1) is potentially feasible. This study aimed to compare the success rate and pacing outcomes of LBBAP guided by MCL1 with those guided by the 12‑lead ECG using an EP recording system. METHODS: This retrospective, single-center study included patients with preserved left ventricular ejection fraction who underwent LBBAP for bradyarrhythmia. LBBAP was either guided by 12‑lead ECG using an EP recording system or by MCL1. In the MCL1 group, a follow-up examination with a 12‑lead ECG using an EP recording system was conducted within one week postoperatively. RESULTS: A total of 65 patients underwent LBBAP (EP recording system group: n = 35; MCL1 group: n = 30). The overall success rate of LBBAP was 84.6%, with no significant difference between groups (88.5% vs. 80.0%, p = 0.49). No significant differences were observed in the paced QRS duration (140.4 ± 8.0 vs. 141.9 ± 13.1 ms, p = 0.54), V6-V1 interpeak interval (39.7 ± 16.5 vs. 38.3 ± 15.6 ms, p = 0.79), or V6 R-wave peak time (69.8 ± 12.3 vs. 71.5 ± 12.1 ms, p = 0.68). CONCLUSIONS: MCL1-guided LBBAP was feasible and achieved a high success rate, with outcomes comparable to those of conventional EP recording system-guided implantation. This simplified approach may reduce procedural complexity and may allow LBBAP implantation without the routine use of an EP recording system.
Spatial proximity or vector orientation? Re-evaluating ECG interpretation in anterior myocardial infarction using cardiac magnetic resonance.
Aslanger EK, Aggül B, İnan D … +9 more , Taşdelen N, Özkök S, Akaslan D, Cabbar AT, Çatal S, Kamalı ÖF, Uysaler E, Yıldırımtürk Ö, Değertekin M
J Electrocardiol · 2026 Jun · PMID 42378794 · Publisher ↗
BACKGROUND: The electrocardiogram (ECG) is widely used to infer infarct location and extent in anterior myocardial infarction (MI), based on either anatomical lead proximity or vectorial orientation of ST-segment deviati...
BACKGROUND: The electrocardiogram (ECG) is widely used to infer infarct location and extent in anterior myocardial infarction (MI), based on either anatomical lead proximity or vectorial orientation of ST-segment deviation. However, the validity of these approaches against direct imaging of myocardial injury remains uncertain. METHODS: In this prospective study, 105 patients with anterior MI underwent cardiac magnetic resonance (CMR) imaging 3-7 days after presentation. Admission ECGs were analyzed using (1) conventional ECG localization categories, and (2) simplified frontal and horizontal ST-axis orientation. CMR-defined injury distribution was assessed using late gadolinium enhancement and myocardial edema imaging. RESULTS: Conventional ECG localization categories demonstrated no significant association with CMR-defined infarct distribution (P = 0.24), with poor agreement (κ = 0.122) and substantial overlap across categories. Simplified ST-axis orientation showed modest and inconsistent associations with infarct location and did not meaningfully explain infarct size. In contrast, global ST-segment burden was associated with CMR-defined infarct size (ΣSTE: standardized β = 0.307, P = 0.002; lead count: standardized β = 0.267, P = 0.007). CONCLUSIONS: In this selected cohort of reperfused LAD-related anterior STEMI patients undergoing early CMR, conventional ECG localization categories and simplified ST-axis orientation showed poor or inconsistent correspondence with CMR-defined infarct distribution, whereas global ST-segment burden showed a modest association with infarct size. These findings suggest that, in this cohort, the ECG may be better suited to reflect the extent of myocardial injury rather than its precise anatomical location.
Pacing spikes without visible QRS complexes: Failure to capture?
Gonzales-Uribe A, Madhavan M, Munoz FD
J Electrocardiol · 2026 Jun · PMID 42365680 · Publisher ↗
A man in his 60s with advanced infra-Hisian conduction disease underwent dual-chamber pacemaker implantation with left bundle branch area pacing. Postimplant telemetry demonstrated intermittent pacing spikes apparently n...
A man in his 60s with advanced infra-Hisian conduction disease underwent dual-chamber pacemaker implantation with left bundle branch area pacing. Postimplant telemetry demonstrated intermittent pacing spikes apparently not followed by QRS complexes, raising concern for failure to capture or lead dislodgment. However, the patient remained asymptomatic and device interrogation showed preserved sensing, stable lead impedance, and normal capture thresholds. Careful inspection of the telemetry tracing revealed preserved T waves and subtle low-amplitude ventricular depolarizations despite the apparent absence of visible QRS complexes. The findings were attributed to telemetry processing artifact with preserved ventricular activation during unipolar left bundle branch area pacing.
Rethinking prediction of sudden cardiac arrest: The role of electrocardiography in forecasting low-incidence, high-consequence events.
Gokhale T, Saba S
J Electrocardiol · 2026 Jun · PMID 42364311 · Publisher ↗
Sudden cardiac arrest (SCA) remains a leading cause of mortality, accounting for 300,000-400,000 deaths annually in the United States. Despite advances in device therapy, current approaches to risk stratification remain...
Sudden cardiac arrest (SCA) remains a leading cause of mortality, accounting for 300,000-400,000 deaths annually in the United States. Despite advances in device therapy, current approaches to risk stratification remain limited in both sensitivity and specificity. This reflects a broader challenge in medicine: predicting low-incidence, high-consequence events, where traditional statistical frameworks often fail to achieve meaningful clinical utility. In this review, SCA is examined as a model problem highlighting key conceptual and methodological challenges, including class imbalance, heterogeneity of mechanisms, ambiguity in defining cases and controls, and temporal variability in risk. Electrocardiography (ECG) is emphasized as a scalable modality capable of capturing important components of the substrate-trigger-autonomic triad. However, existing ECG-based markers have not translated into robust clinical tools and recent machine learning approaches have not yet overcome this translational gap. We argue that the central translational gap is not the absence of stronger predictors, but insufficient specification of the clinical decisions, target populations, and performance thresholds against which model utility should be evaluated. Within this framework, ECG feature selection should be matched to the mechanistic target: depolarization markers index structural substrate, repolarization markers capture dynamic electrical instability, and autonomic markers reflect modulatory state, each operating on distinct timescales. Population decomposition into mechanistically coherent subproblems, rather than pursuit of a single overarching prediction model, is likely to accelerate both performance and clinical translation. Lessons learned from SCA may extend broadly to other high-impact, low-frequency conditions in medicine.
New subtle anterior Q-wave and LAD occlusion.
Tomcsányi J, Kollár L, Csákányi M
J Electrocardiol · 2026 Jun · PMID 42364310 · Publisher ↗
A 59-year-old patient presented with myocardial infarction. The 12‑lead ECG showed no diagnostic ST segment elevation:however, subtle abnormalities were present in the anterior leads. Immediate coronary angiography confi...
A 59-year-old patient presented with myocardial infarction. The 12‑lead ECG showed no diagnostic ST segment elevation:however, subtle abnormalities were present in the anterior leads. Immediate coronary angiography confirmed occlusion of the left anterior descending coronary artery. This case suggests that newly appearing subtle anterior Q-waves may rise suspicion for left anterior descending coronary artery occlusion.
Monday-to-Friday workweek trajectory of ventricular repolarization and heart rate variability in apparently stable adults: A repeated-measures study.
Cosgun A, Oren H
J Electrocardiol · 2026 Jun · PMID 42361427 · Publisher ↗
BACKGROUND: Cardiovascular events show temporal clustering at the beginning of the workweek, but whether ventricular repolarization and autonomic regulation follow a Monday-to-Friday workweek trajectory remains insuffici...
BACKGROUND: Cardiovascular events show temporal clustering at the beginning of the workweek, but whether ventricular repolarization and autonomic regulation follow a Monday-to-Friday workweek trajectory remains insufficiently defined. We evaluated within-subject changes in electrocardiographic repolarization markers and heart rate variability (HRV) in apparently stable adults without overt cardiovascular disease. METHODS: In this repeated-measures study, 85 participants underwent serial resting 12‑lead electrocardiography and five consecutive 24-h Holter recordings from Monday through Friday. Ventricular repolarization indices, including T-peak-to-T-end (Tp-e), QT, QTc, QTcF, Tp-e/QT, and Tp-e/QTc, and HRV parameters, including SDNN, RMSSD, and pNN50, were assessed. Monday-to-Friday changes were evaluated using repeated-measures ANOVA and linear mixed-effects models with participant-specific random intercepts. Sequential models were adjusted for age, sex, mean 24-h heart rate, perceived stress, and physical activity. RESULTS: Tp-e values were highest on Monday and progressively decreased toward Friday (p < 0.001). In contrast, SDNN, RMSSD, and pNN50 increased over the same observation window, suggesting improved vagal modulation. Raw QT intervals lengthened as mean heart rate declined, whereas corrected QT indices showed modest, non-monotonic variation. In fully adjusted mixed-effects models, the Monday-to-Friday weekday variable remained independently associated with Tp-e. Higher perceived stress and mean heart rate were associated with longer Tp-e, whereas greater physical activity was associated with shorter Tp-e. CONCLUSIONS: In apparently stable adults, repolarization heterogeneity and autonomic indices showed a Monday-to-Friday within-subject workweek trajectory. These findings should be interpreted as observational workweek-related associations, not as evidence of a complete weekly cycle, weekend recovery, or causal linkage with cardiovascular events.
What the electrocardiogram is being asked to detect in acute myocardial infarction: The case for the OMI/NOMI paradigm.
de Alencar JN
J Electrocardiol · 2026 Jun · PMID 42335794 · Publisher ↗
The electrocardiogram is the pivotal triage instrument in suspected acute myocardial infarction, yet for three decades its interpretation has been reduced to a single feature: whether ST-segment elevation meets a fixed m...
The electrocardiogram is the pivotal triage instrument in suspected acute myocardial infarction, yet for three decades its interpretation has been reduced to a single feature: whether ST-segment elevation meets a fixed millimeter threshold. Approximately one-quarter to one-third of patients labeled non-ST-segment elevation myocardial infarction (NSTEMI) harbor total culprit artery occlusion at next-day angiography, sustain infarct sizes and mortality comparable to or worse than ST-segment elevation myocardial infarction (STEMI), and are younger and less comorbid - indicating that adverse outcomes reflect delayed reperfusion rather than baseline risk. The occlusion myocardial infarction versus non-occlusion myocardial infarction (OMI/NOMI) framework reorients electrocardiographic interpretation around acute coronary occlusion rather than a single morphological criterion. This review examines the principal arguments advanced in defense of the ST-elevation-only reading standard as electrocardiographic propositions: what the electrocardiogram is being asked to detect, what it predicts when read for occlusion, how its interpretation shapes the timing and selection of reperfusion, and whether an expanded reading standard can be operationalized without loss of diagnostic performance. The evidence shows that the call for dedicated randomized trials misunderstands a purely diagnostic paradigm, that early-invasive trials in NSTEMI were neither early nor selective, that fibrinolytic benefit in non-ST-elevation occlusion was obscured by heterogeneous pooling, and that expanded interpretation - increasingly scalable through artificial intelligence - improves sensitivity and specificity simultaneously. The electrocardiogram has not failed; the reading standard applied to it has.
A rare rhythm in a pulseless patient: ECG challenge.
Shoua N, Suleiman M
J Electrocardiol · 2026 Jun · PMID 42314406 · Publisher ↗
We report a case of cardiac arrest with an initial monitor rhythm suggesting Wide Complex Tachycardia (WCT). However, unique circumstances allowed for a 12 ECG to be obtained, which revealed ventricular standstill. The a...
We report a case of cardiac arrest with an initial monitor rhythm suggesting Wide Complex Tachycardia (WCT). However, unique circumstances allowed for a 12 ECG to be obtained, which revealed ventricular standstill. The apparent rhythm was a pseudo-tachycardia artifact caused by monitor auto-gain amplification. This case highlights the risk of automated signal processing artifacts mimicking life-threatening arrhythmias during ACLS.
Letter to the editor: DeepECG.ai: An AI-enhanced ECG analysis platform to bridge the expertise gap from primary care to cardiology.
Wisana IDGH, Luthfiyah S, Triwiyanto T … +1 more , Ismath M
J Electrocardiol · 2026 Jun · PMID 42309942 · Publisher ↗
Abstract loading — click title to view on PubMed.
Prediction of Elevated Troponin T Levels from Prehospital Electrocardiograms.
Knudsen A, Struijk JJ, Riahi S … +7 more , Hasselbalch RB, Andersen MP, Christensen HC, Torp-Pedersen C, Polcwiartek C, Kragholm K, Graff C
J Electrocardiol · 2026 Jun · PMID 42296763 · Publisher ↗
BACKGROUND: Early and reliable predictions of elevated cardiac troponin levels from electrocardiograms (ECGs) in the prehospital setting could serve as a valuable risk stratification tool, guiding triage and early interv...
BACKGROUND: Early and reliable predictions of elevated cardiac troponin levels from electrocardiograms (ECGs) in the prehospital setting could serve as a valuable risk stratification tool, guiding triage and early intervention in patients with suspected acute coronary syndrome, and especially in patients presenting with electrocardiographic non-ST elevation (NSTE). Therefore, the primary objective of this study was to investigate whether machine learning applied to the prehospital ECG can enable early identification of patients at high risk of myocardial infarction. METHODS AND RESULTS: A total of 100,334 patients with a prehospital ECG and in-hospital troponin measurement available were included in this study. A random forest model was developed to predict elevated cardiac troponin T (>14 ng/L) from the prehospital ECG. Mean age was 64.72 (17.05) and 55.13% of the cohort were male. Five-fold cross-validation showed an area under the receiver operating characteristics curve of 0.88 and area under the precision-recall curve of 0.89. Positive predictive value was 0.80 and negative predictive value was 0.79. Results on the internal independent test cohort and achieved similar performance. Supplementary analyses showed that the model was able to identify NSTE patients with elevated troponin T as well as identified a gap in time to definitive treatment for NSTE patients compared to those with ST elevation (STE). CONCLUSION: Machine learning applied to the prehospital ECG can identify patients at high risk of myocardial injury before biomarker results are available, with potential to streamline patient flow and reduce time to definitive treatment in patients with suspected acute coronary syndrome.
First beat antitachycardia pacing termination of monomorphic ventricular tachycardia by an extravascular defibrillator.
Cantero PA, Ruiz RM, Olarte J … +2 more , Garrido Jiménez JM, Jiménez-Jaimez J
J Electrocardiol · 2026 Jun · PMID 42287923 · Publisher ↗
Antitachycardia pacing (ATP) delivered by implantable cardioverter-defibrillators (ICD) is a well-established therapy for monomorphic ventricular tachycardia (VT). Recently, extravascular ICD has emerged as a novel techn...
Antitachycardia pacing (ATP) delivered by implantable cardioverter-defibrillators (ICD) is a well-established therapy for monomorphic ventricular tachycardia (VT). Recently, extravascular ICD has emerged as a novel technique that provides ATP with an entirely extravenous system, at the epicardial level. ECG documentation of a succesful ATP delivery by this innovative ICD is a rare but stimulating report. We present a case of sustained monomorphic VT successfully terminated by the first ATP stimulus delivered by an extravascular ICD, with surface ECG documentation of the termination beat. Beyond documenting successful ATP therapy, the recording also provides insight into the electrophysiological interaction between the paced impulse and the VT circuit, suggesting potential mechanistic information about the underlying reentrant substrate.
The illusion of simplicity: Diagnostic inconsistencies within the STEMI paradigm.
Frick WH, Smith SW
J Electrocardiol · 2026 Jun · PMID 42287922 · Publisher ↗
BACKGROUND: The ST-elevation myocardial infarction (STEMI) paradigm relies on the assumption that specific millimeter-based ST-segment elevation criteria serve as a reliable surrogate for acute coronary occlusion. While...
BACKGROUND: The ST-elevation myocardial infarction (STEMI) paradigm relies on the assumption that specific millimeter-based ST-segment elevation criteria serve as a reliable surrogate for acute coronary occlusion. While proponents advocate for the simplicity and uniformity of these criteria, the paradigm often fails to reflect the underlying pathophysiologic reality captured in the Occlusion Myocardial Infarction (OMI) paradigm. CASE PRESENTATION: A 65-year-old male presented with acute chest pain and an initial electrocardiogram (ECG) specific for left anterior descending coronary artery (LAD). Despite these findings, the ECG was negative for STEMI millimeter criteria. Management was delayed as the patient was categorized as having a non-ST elevation myocardial infarction (NSTEMI). Coronary angiography performed 15 h after presentation revealed an acute total thrombotic occlusion of the LAD. DISCUSSION: This case illustrates the "illusion of simplicity" within the STEMI paradigm, where clinical documentation and intervention timing were dictated more by benchmark-driven diagnostic labels than by objective evidence of coronary occlusion. Evidence suggests that standard STEMI criteria fail to identify up to 38% of LAD occlusions, whereas expert interpretation and AI models have far higher sensitivity. CONCLUSION: The STEMI paradigm's purported uniformity is inconsistent over time and often reflects physician attainment of "door-to-balloon" metrics rather than the patient's physiological state. To improve diagnostic accuracy and patient outcomes, clinical practice must transition from the STEMI paradigm to the more physiologically accurate OMI paradigm.
Unravel the pacing: ECG of the month.
Kaushik A, Jaswal A, Raina S … +1 more , Ejituwu JU
J Electrocardiol · 2026 Jun · PMID 42276028 · Publisher ↗
An 84-year-old patient with permanent pacemaker presented with shortness of breath for 2 weeks. At presentation her ECG showed an interesting pause which was explained by the occurrence of atrial premature complex (APC)...
An 84-year-old patient with permanent pacemaker presented with shortness of breath for 2 weeks. At presentation her ECG showed an interesting pause which was explained by the occurrence of atrial premature complex (APC) in the post-ventricular atrial refractory period (PVARP). Through this ECG we try to explain the importance of post-ventricular atrial refractory period and post-ventricular atrial blanking period.
Predictive value of ventricular repolarization parameters for ventricular arrhythmias in patients with non-ischemic heart failure (ventricular repolarization & arrhythmia prediction in non-ischemic heart failure).
Bıçakçı YD, Gülçebi F, Özderya A … +1 more , Sayın MR
J Electrocardiol · 2026 Jun · PMID 42276027 · Publisher ↗
BACKGROUND: Ventricular arrhythmias are a major cause of mortality in patients with heart failure. Although implantable cardioverter-defibrillators (ICDs) reduce arrhythmic death, risk stratification remains suboptimal....
BACKGROUND: Ventricular arrhythmias are a major cause of mortality in patients with heart failure. Although implantable cardioverter-defibrillators (ICDs) reduce arrhythmic death, risk stratification remains suboptimal. This study aimed to evaluate the association between electrocardiographic ventricular repolarization parameters and malignant ventricular arrhythmias in patients with non-ischemic heart failure (NIHF). METHODS: This retrospective cohort study included 85 patients with NIHF who underwent ICD implantation between 2016 and 2022. Patients were categorized according to the occurrence of ventricular arrhythmias within three years after ICD implantation. Baseline electrocardiographic, echocardiographic, laboratory, and demographic data were compared between groups. RESULTS: Ventricular arrhythmias developed in 36% of patients. QT interval (430 ms, p < 0.001), QTc interval (439.7 ms, p < 0.001), Tpeak-Tend interval (Tp-e) (85 ms, p = 0.003), and QRS duration (112.8 ms, p = 0.013) were significantly prolonged in patients with arrhythmias. In multivariable regression analysis, QTc demonstrated the strongest association with ventricular arrhythmias. ROC analysis revealed a QTc cut-off value of 428.5 ms (sensitivity 74.2%, specificity 74.1%, AUC: 0.775, 95% CI: 0.675-0.876, p < 0.001). Sensitivity analysis after exclusion of amiodarone users showed persistence of the QTc association in univariable and ROC analyses, although attenuation was observed in multivariable analysis. CONCLUSION: QTc and Tp-e parameters may provide useful information for ventricular arrhythmic risk assessment in patients with NIHF. Larger prospective studies are needed to validate their independent predictive value and clinical applicability.
The prognostic value of ECG parameters in 20-year cardiovascular risk, and in SCORE2-based prediction modelling; the ATTICA cohort study (2002-2022).
Chrysohoou C, Iliakis P, Xydis P … +7 more , Giannakopoulou SP, Konstantinou K, Dimitriadis K, Tsioufis K, Pitsavos C, Panagiotakos D, ATTICA Study investigators
J Electrocardiol · 2026 · PMID 42241964 · Publisher ↗
BACKGROUND: We aimed to evaluate the prognostic value of electrocardiographic (ECG) parameters in estimating long-term cardiovascular disease (CVD) risk and their incremental predictive value when added to the HellenicSC...
BACKGROUND: We aimed to evaluate the prognostic value of electrocardiographic (ECG) parameters in estimating long-term cardiovascular disease (CVD) risk and their incremental predictive value when added to the HellenicSCORE II+ model in an apparently healthy adult population. METHODS: This analysis included 1482 participants (mean age 46 ± 15 years; 49% male) from the population-based prospective ATTICA study who had baseline ECG recordings, comprehensive clinical and biochemical assessment, and complete 20-year follow-up data. RESULTS: During the 20-year follow-up period, 633 of the 1482 participants (43%) experienced a first fatal or non-fatal CVD event. Out of these, 86 were fatal, leading to a 20-year CVD mortality rate of 9.5% in males and 2.4% in females (p < 0.001). QT interval and QRS duration showed significant associations for both 10-year and 20-year CVD risk, with a 10 ms prolongation in QT interval to be associated with a 4.0% increase in 10-year CVD risk (HR:1.040, 95%CI:1.017-1.064) and a 5.3% increase in 20-year CVD risk (HR:1.053, 95%CI:1.038-1.068), while the same prolongation in the QRS duration was linked to a 33.6% increase in 10-year CVD risk (HR:1.336, 95%CI:1.213-1.470) and 37.2% increase in 20-year CVD risk (HR:1.372, 95%CI:1.287-1.463). The inclusion of QRS duration increased the HellenicSCORE II+ model's performance, yielding superior discrimination and reclassification measures and improving overall risk stratification. CONCLUSIONS: Routine ECG parameters, particularly QRS duration, enhance long-term CVD risk prediction beyond established clinical models. Given the wide availability and low cost of ECG, these findings support further validation and integration of ECG-derived markers into preventive risk assessment strategies.
Electrocardiographic markers of right heart strain and their association with arrhythmias in patients with COPD.
Kocikj N
J Electrocardiol · 2026 · PMID 42229002 · Publisher ↗
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is frequently associated with cardiovascular complications, including right heart dysfunction and cardiac arrhythmias. Chronic hypoxia and pulmonary vascular remod...
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is frequently associated with cardiovascular complications, including right heart dysfunction and cardiac arrhythmias. Chronic hypoxia and pulmonary vascular remodeling may lead to structural and electrical cardiac changes. Electrocardiography (ECG) may provide simple markers of right heart strain that could help identify COPD patients at increased arrhythmic risk. OBJECTIVE: To evaluate the association between ECG markers of right heart strain and arrhythmias and to identify independent predictors using multivariable analysis. METHODS: This cross-sectional observational study included 80 consecutive patients with confirmed COPD treated in a secondary healthcare center. All patients underwent standard 12‑lead ECG and 24-h Holter monitoring. COPD diagnosis and severity were defined according to GOLD criteria. Arrhythmias included atrial fibrillation, supraventricular tachycardia, premature ventricular contractions, and other clinically relevant rhythm disturbances. Patients were divided into two groups: with arrhythmias (n = 40) and without arrhythmias (n = 40). ECG parameters included P pulmonale, right axis deviation (RAD), right ventricular hypertrophy (RVH), T-wave inversion in V1-V3, low QRS voltage and right bundle branch block (RBBB). Multivariable logistic regression analysis was performed adjusting for age, sex, FEV₁, hypertension, diabetes, and cardiovascular risk factors. RESULTS: ECG abnormalities were significantly more prevalent in patients with arrhythmias. P pulmonale was more frequent in the arrhythmia group (55% vs. 20%, p = 0.002), although analysis was restricted to patients in sinus rhythm. RAD (62.5% vs. 20%, p < 0.001), RVH (45% vs. 15%, p = 0.007), T-wave inversion (65% vs. 30%, p = 0.003), and RBBB (60% vs. 20%, p < 0.001) were significantly more common in patients with arrhythmias. Low QRS voltage did not differ significantly between groups (70% vs. 55%, p = 0.20). On multivariable analysis, P pulmonale (OR 3.2, 95% CI 1.3-7.8, p = 0.01) and RVH (OR 2.9, 95% CI 1.1-7.2, p = 0.03) were independent predictors of arrhythmias. CONCLUSION: ECG markers of right heart strain, particularly P pulmonale and RVH, are independent predictors of arrhythmias in COPD patients. ECG may serve as a simple, non-invasive tool for early risk stratification and identification of patients who may benefit from closer rhythm monitoring. The relatively small sample size and single-centre design may limit the generalizability of the findings.
Beyond STEMI and OMI: What does the ST segment really represent?
Mc Loughlin MJ
J Electrocardiol · 2026 · PMID 42208476 · Publisher ↗
Abstract loading — click title to view on PubMed.
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