Journal Of Electrocardiology[JOURNAL]
Sun
200 papers
Simple ECG features predict successful catheter ablation of idiopathic premature ventricular contractions with an inferior axis.
Mueller-Leisse J, Syrbius G, Hillmann HAK … +6 more , Eiringhaus J, Hohmann S, Zormpas C, Karfoul N, Duncker D, Veltmann C
J Electrocardiol · 2026 · PMID 42184567 · Publisher ↗
BACKGROUND: Numerous algorithms predict the origin of idiopathic premature ventricular contractions (PVCs) with an inferior axis using the electrocardiogram (ECG), especially trying to differentiate between PVCs from the...
BACKGROUND: Numerous algorithms predict the origin of idiopathic premature ventricular contractions (PVCs) with an inferior axis using the electrocardiogram (ECG), especially trying to differentiate between PVCs from the left and right ventricular outflow tract (LVOT and RVOT). Although evaluating the PVC origin goes along with evaluating risks and benefits of catheter ablation, this approach is complex for non-electrophysiology (EP) experts and shows limited reliability. As an additional strategy to guide decision-making, we sought to find simple ECG criteria that predict outcome of catheter ablation directly rather than origin. METHODS: Patients undergoing catheter ablation of idiopathic PVCs with an inferior axis at our center between 2012 and 2020 were included. Procedural data assessed included complete suppression of the PVC at the end of the procedure, ECG analysis included assessment of Q-, R-, and S-amplitudes, -durations and derived parameters. RESULTS: 104 patients (54% male, 54 ± 17 years) were included. Overall ablation success was 81%. Two ECG features - a more leftward PVC axis in the limb leads and an earlier precordial transition in the chest leads - independently predicted ablation failure. Using ROC statistics, we suggest combining the following two criteria to predict ablation success with a positive predictive value of 95% with no major complications: (1) PVC axis ≥ 75° (lead III ≥ (neg) aVR) and (2) TZ-score > 2 (V2 net negative, p < 0.001). If either parameter was not met, success rate was only 60% and major complication rate was 7%. Considering the PVC origin underlying these findings, the two criteria were inversely associated with a parahisian and LV summit origin, while no differences in ablation success or procedural data were observed between RVOT and LVOT origins. CONCLUSION: While catheter ablation of LVOT and RVOT PVCs show similarly high success rates, two simple ECG criteria based on PVC axis and precordial transition independently predict ablation outcome due to complex PVC foci. These should be considered when evaluating patients with idiopathic PVCs with an inferior axis for catheter ablation.
ECG Challenge: Unveiling an Unusual Wide Complex Rhythm.
Panyala N, Saleh A, Patel H
J Electrocardiol · 2026 · PMID 42184566 · Publisher ↗
Abstract loading — click title to view on PubMed.
Relationship between fragmented QRS and serum fibroblast growth factor-23 in hypertensive patients with left ventricular hypertrophy.
Bebek B, Karabulut A, Eser B … +7 more , Sarıhan A, Birgün A, Özden M, Yetim M, Kalçık M, Bekar L, Biter B
J Electrocardiol · 2026 · PMID 42177867 · Publisher ↗
BACKGROUND: Hypertensive heart disease is frequently accompanied by left ventricular hypertrophy (LVH) and myocardial fibrosis, which contribute to diastolic dysfunction and adverse cardiovascular outcomes. Fragmented QR...
BACKGROUND: Hypertensive heart disease is frequently accompanied by left ventricular hypertrophy (LVH) and myocardial fibrosis, which contribute to diastolic dysfunction and adverse cardiovascular outcomes. Fragmented QRS (fQRS) on surface electrocardiography has been associated with myocardial fibrosis and is considered a potential noninvasive marker of myocardial fibrosis. Fibroblast growth factor-23 (FGF-23), a key regulator of mineral metabolism, has been implicated in myocardial remodeling and fibrosis; however, its relationship with fQRS in hypertensive patients with LVH has not been fully elucidated. METHODS: In this cross-sectional, single-center study, 265 patients with isolated hypertension and echocardiographically confirmed LVH were enrolled. All participants underwent clinical evaluation, laboratory testing, transthoracic echocardiography, and 12‑lead electrocardiography. Serum FGF-23 levels were measured using a sandwich enzyme-linked immunosorbent assay. Patients were compared according to the presence or absence of fQRS. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the discriminative ability of FGF-23 and left ventricular mass index (LVMI) for predicting fQRS. RESULTS: Fragmented QRS was present in 55 patients (20.8%). Patients with fQRS had significantly higher serum FGF-23 levels compared with those without fQRS (835.1 ± 153.4 vs. 670.7 ± 223.7 pg/mL, p < 0.001). The fQRS-positive group also exhibited higher LVMI and a lower E/A ratio, indicating impaired diastolic function (all p < 0.01). ROC analysis demonstrated that FGF-23 had a moderate ability to predict the presence of fQRS (AUC = 0.734, 95% CI: 0.661-0.808), exceeding that of LVMI (AUC = 0.654, 95% CI: 0.574-0.735). CONCLUSIONS: In hypertensive patients with LVH, the presence of fQRS is associated with elevated serum FGF-23 levels, increased LVMI, and impaired diastolic function. These findings suggest a potential link between FGF-23-related pathways and possible myocardial fibrotic remodeling, and support the complementary value of FGF-23 alongside electrocardiographic markers in risk stratification.
Development and internal validation of QRSense: A portable tool for manual and structured measurement of electrocardiograms in digital tracings.
Obregón-Rosas S, Montañez-Aguirre ÁA, Navarrete-Punaro JP … +8 more , Cardoso-Pérez V, Horta-Hurtado C, García-Almazán D, Rojas-Bergés I, Morales-Sánchez DE, Hernández-Alcaraz FC, Morales-Rios JL, Bracamonte-Palma R
J Electrocardiol · 2026 · PMID 42176693 · Publisher ↗
INTRODUCTION: Manual electrocardiogram (ECG) measurement entails inter-observer variability that affects clinical reproducibility. QRSense was developed as an open-source, offline digital tool to standardize this process...
INTRODUCTION: Manual electrocardiogram (ECG) measurement entails inter-observer variability that affects clinical reproducibility. QRSense was developed as an open-source, offline digital tool to standardize this process. OBJECTIVE: To describe the technical characteristics and to evaluate the measurement agreement and reproducibility of QRSense compared with conventional manual measurement. METHODS: A client-side web application based on HTML5 Canvas was developed for vector-based measurements without automation. Subsequently, a cross-sectional concordance study was conducted using 50 consecutively selected ECG tracings. Eight independent observers measured QRS duration and voltage, divided into two groups of four observers each (four using QRSense and four using manual methods). Agreement between methods was assessed with Bland-Altman analysis (bias and 95% limits of agreement) and Lin's Concordance Correlation Coefficient (CCC) as the primary metric of exact agreement. RESULTS: Excellent exact agreement was observed for both parameters: Lin's CCC was 0.9527 for QRS voltage and 0.9221 for QRS duration. Bland-Altman analysis showed a negligible mean bias of +0.0482 mV for voltage (95% limits of agreement: -0.0958 to +0.1922 mV) and a small bias of -1.32 ms for duration (95% limits of agreement: -16.24 to +13.59 ms), without proportional trends across the measurement range. CONCLUSION: QRSense is a valid and reliable tool. It offers measurement agreement comparable to expert human measurement and supports reproducible quantification of ECG parameters, facilitating the standardization and auditability of electrocardiographic data for research and clinical practice.
DeepECG.ai: An AI-enhanced ECG analysis platform to bridge the expertise gap from primary care to cardiology.
Nolin-Lapalme A, Tastet O, Sowa A … +8 more , Delfrate J, El Adib I, Morisset J, Ahuja R, Banerjee R, Lessard MG, Vadeboncoeur A, Avram R
J Electrocardiol · 2026 · PMID 42176692 · Publisher ↗
BACKGROUND: Despite numerous open-source deep learning models for ECG interpretation achieving expert-level performance, the field lacks integrated platforms for systematic model evaluation beyond standard accuracy metri...
BACKGROUND: Despite numerous open-source deep learning models for ECG interpretation achieving expert-level performance, the field lacks integrated platforms for systematic model evaluation beyond standard accuracy metrics. Current implementations require substantial computational expertise and fail to assess critical translational aspects including interventional contexts, clinical workflow integration, and real-world robustness. DeepECG.ai addresses this gap by providing a unified platform for comprehensive model testing and deployment. METHODS: We developed DeepECG.ai, a web-based platform that integrates with existing clinical ECG systems to deliver AI-powered decision support within just a few clicks. The platform processes 12‑lead ECGs through AI models and delivers clinical recommendations based on the deployed model's focus. Two clinical studies leverage this system: DAISEA-ECG (ongoing), focused on comprehensive analysis in primary care, and HEART-AI (ongoing), targeting structured cardiology screening. RESULTS: The platform successfully integrates electrophysiological systems across care settings. AI models for comprehensive ECG analysis and structural heart disease prediction are operational on a web-based, secure platform. Both clinical validation studies are active with completed user training and operational data collection infrastructure. Within the first three months of the HEART-AI study (since its launch in April 2025), 29,211 ECGs were analyzed, with inference times under one second per ECG. During this period, 53 users provided consent and actively participated, contributing to the enrollment of 285 patients. CONCLUSIONS: We have successfully developed the DeepECG.ai platform that bridges expertise gaps across the healthcare continuum, delivering actionable decision support to both non-specialist and specialist users. This implementation lays a robust foundation for evaluating AI's impact on diagnostic accuracy, workflow efficiency, and patient outcomes.
Nightly sleep as a predictor of next-day arrhythmias in ambulatory adults.
Randa L, Lee C, Cheng J … +5 more , Fang CD, Rosenthal DG, Wilson E, Olgin JE, Marcus GM
J Electrocardiol · 2026 · PMID 42172865 · Publisher ↗
BACKGROUND: The frequency of cardiac ectopy, including premature atrial contractions (PACs), premature ventricular contractions (PVCs), non-sustained supraventricular tachycardia (SVT), and non-sustained ventricular tach...
BACKGROUND: The frequency of cardiac ectopy, including premature atrial contractions (PACs), premature ventricular contractions (PVCs), non-sustained supraventricular tachycardia (SVT), and non-sustained ventricular tachycardia (NSVT), is clinically relevant, but modifiable risk factors remain poorly understood. Sleep quality influences the risk for atrial fibrillation, but whether sleep might predict the frequency of these even more common arrhythmias is unknown. PURPOSE: To investigate whether sleep duration, sleep disturbances, and self-rated sleep quality predict next-day common arrhythmias in an ambulatory population. METHODS: This was a secondary analysis of the Coffee and Real-time Atrial and Ventricular Ectopy (CRAVE) trial, a randomized, 14-day case-crossover trial of the effects of coffee in 100 healthy volunteers. The current analyses utilized data from a wrist-worn accelerometer to measure sleep duration and disturbances worn concomitantly with a continuously recording electrocardiogram. Participants self-rated sleep quality via daily surveys. Negative binomial and logistic mixed-effects models were used to assess the effect of sleep on cardiac ectopy, adjusting for day of the week and randomization assignment and accounting for repeated measurement correlations within individuals. RESULTS: The frequency of cardiac ectopy was not associated with sleep duration (RR, 0.99; 95% CI, 0.95-1.03), sleep disturbances (RR, 0.99; 95% CI, 0.95-1.03), or sleep quality (RR, 0.97; 95% CI, 0.91-1.04). There were no significant associations between the same predictors and individual counts of PACs or PVCs or episodes of SVT or NSVT. CONCLUSION: We failed to find evidence of a relationship between objectively quantified sleep and continuous assessment of common arrhythmias the following day in healthy volunteers.
Emphysematous gastritis presenting as a Pseudo-inferior myocardial infarction due to cardiac displacement.
Rein B, Forohar D, Sharma R … +1 more , Hanna A
J Electrocardiol · 2026 · PMID 42172864 · Publisher ↗
This case explores emphysematous gastritis manifesting as transient inferior ST-segment elevation on electrocardiogram (ECG), mimicking acute myocardial infarction. The patient presented with symptoms and ECG findings in...
This case explores emphysematous gastritis manifesting as transient inferior ST-segment elevation on electrocardiogram (ECG), mimicking acute myocardial infarction. The patient presented with symptoms and ECG findings initially concerning for inferior wall myocardial infarction. Negative cardiac biomarkers, normal echocardiography, and resolution of ECG abnormalities following gastric decompression supported an extracardiac etiology. Emphysematous gastritis is an uncommon but life-threatening condition, with fewer than 100 cases reported, and no previous description of causing a pseudo-infarction pattern on ECG. This case highlights the importance of recognizing extracardiac causes of ST-segment elevation and integrating clinical context, biomarkers, and imaging to avoid unnecessary invasive cardiac intervention.
QRS notch timing in idiopathic outflow tract premature ventricular complexes.
Jaouadi A, Turan OE, Yilancioglu RY … +3 more , Inevi U, Karaoglan S, Ozcan EE
J Electrocardiol · 2026 · PMID 42155230 · Publisher ↗
BACKGROUND AND AIMS: The precise preprocedural localization of outflow tract premature ventricular contractions (OT-PVCs) remain essential yet challenging, owing to the region's complex and variable anatomy, particularly...
BACKGROUND AND AIMS: The precise preprocedural localization of outflow tract premature ventricular contractions (OT-PVCs) remain essential yet challenging, owing to the region's complex and variable anatomy, particularly for left-sided origins. Although numerous electrocardiographic localization algorithms have been proposed, most are constrained by a trade-off between diagnostic accuracy and clinical practicality. QRS notching is a frequently observed but largely overlooked feature in OT-PVCs, and it remains understudied in the context of idiopathic ventricular arrhythmias. This study aims to move beyond a simple analysis of notch distribution across leads by leveraging QRS notching as a functional marker of ventricular activation to enhance site of origin localization. METHODS: This retrospective observational study included 105 patients who underwent successful catheter ablation for symptomatic OT-PVCs. The cohort consisted of 57 right ventricular outflow tract (RVOT) and 48 left ventricular outflow tract (LVOT) PVCs. All PVCs exhibited a left bundle branch block morphology with an inferior axis, defined by a dominant R-wave in the inferior leads and a QS complex in leads aVL and aVR. Furthermore, each PVC demonstrated a single, reproducible notch with a duration of ≤20 ms. Notch Timing (NT) was defined as the interval from the earliest onset of the global PVC QRS complex to the nadir of the identifiable notch. When notches were asynchronous across the 12 leads, the timing of the latest-occurring notch was recorded for analysis. The diagnostic performance of the NT criterion for differentiating RVOT from LVOT origins was evaluated and compared against the V2S/V3R index using receiver operating characteristic (ROC) curve analysis, with the area under the curve (AUC) serving as the primary metric of comparison. RESULTS: Of 105 patients (45.6 ± 13.4 years, 55% male), 57 had RVOT and 48 had LVOT PVCs. NT robustly differentiated origins, with RVOT PVCs demonstrating significantly later notches than LVOT PVCs (94.3 ± 15.0 ms vs. 74.5 ± 15.6 ms, p < 0.001). An NT >80 ms favored an RVOT origin with 87.7% sensitivity and 68.8% specificity (PPV = 76,9%, NPV = 78,1%, AUC 0.838). The diagnostic performance of NT was comparable to the established V2S/V3R index (AUC 0.828). Characteristic lead distribution patterns augmented localization, though extensive notching across both the inferior and lateral precordial leads was not specific for a free-wall RVOT origin. CONCLUSION: This study introduces the first structured framework for QRS notch analysis-defining its characteristics, timing, and distribution-to improve arrhythmia localization. This represents a shift from descriptive morphology to mechanistic interpretation, where a novel notch timing metric robustly discriminates RVOT from LVOT origins by quantifying delayed transeptal conduction.
Prevalence and characteristics of normal electrocardiograms in hypertrophic cardiomyopathy.
Guler A, Gorgulu BK, Surgit O … +15 more , Tanboga IH, Turkmen I, Atmaca S, Sahin H, Gundogdu MC, Almasri M, Yartasi U, Pay D, Coskun G, Salduz D, Aydin S, Serbest NG, Cansever AT, Karacan M, Guler GB
J Electrocardiol · 2026 · PMID 42155229 · Publisher ↗
BACKGROUND: Hypertrophic cardiomyopathy (HCM) is a genetic heart disease characterized by left ventricular hypertrophy (LVH) in the absence of other causes. More than 90% of patients exhibit abnormalities such as T wave...
BACKGROUND: Hypertrophic cardiomyopathy (HCM) is a genetic heart disease characterized by left ventricular hypertrophy (LVH) in the absence of other causes. More than 90% of patients exhibit abnormalities such as T wave inversion, Q waves, or LVH voltage criteria. However, a small subgroup with milder disease may present with a normal electrocardiogram (ECG), which can delay diagnosis. This study aimed to determine the prevalence and clinical characteristics of HCM patients with a normal ECG and their relationship with indicators of disease severity. METHODS: Patients diagnosed with HCM according to European Society of Cardiology (ESC) guideline criteria were retrospectively evaluated. Those with alternative causes of LVH or infiltrative/storage cardiomyopathies were excluded. Abnormal ECG was defined by the presence of atrial fibrillation, conduction block, pathological Q waves, repolarization changes, LVH voltage, low voltage, QTc >460 ms, or QRS >120 ms. RESULTS: Among 682 patients, 11 (1.6%) had completely normal ECGs. The most frequent abnormalities were repolarization changes (82.6%) and LVH voltage criteria (70.2%). Normal ECGs were associated with lower NT-proBNP, lower pulmonary artery pressudre, better right ventricular function, and less frequent late gadolinium enhancement on cardiac magnetic resonance imaging (CMR). The number of ECG abnormalities correlated positively with wall thickness, NT-proBNP, left atrial diameter, pulmonary pressures, and sudden cardiac death (SCD) risk score, but negatively with right ventricular functionand left ventricular ejection fraction. CONCLUSION: A completely normal ECG was observed in only 1.6% of patients with hypertrophic cardiomyopathy. While a normal ECG substantially lowers the likelihood of HCM, it does not exclude the diagnosis. Despite advances in imaging, the ECG remains a simple, accessible, and indispensable screening tool for early detection.
Spatial QRS-T angle and quantified ischemia burden in ischemia with nonobstructive coronary arteries.
Yıldırım A, Ateş MS, Sökmen E
J Electrocardiol · 2026 · PMID 42150233 · Publisher ↗
BACKGROUND: Ischemia with non-obstructive coronary arteries (INOCA) is increasingly recognized as a clinically relevant entity, yet effective risk stratification remains limited. The spatial QRS-T (sQRS-T) angle integrat...
BACKGROUND: Ischemia with non-obstructive coronary arteries (INOCA) is increasingly recognized as a clinically relevant entity, yet effective risk stratification remains limited. The spatial QRS-T (sQRS-T) angle integrates global depolarization-repolarization heterogeneity and may reflect ischemic burden more accurately than conventional ECG markers. METHODS: This retrospective study included 1432 INOCA patients with reversible perfusion defects on myocardial perfusion scintigraphy (MPS) and no ≥50% epicardial stenosis on angiography. Ischemic burden was quantified as the percentage of left ventricular (LV) myocardium with reversible defects and categorized as <5%, 5-10%, or > 10%. Spatial and frontal QRS-T angles, QT dispersion (QTd), QTc, P-wave dispersion, Tpe interval, and Tpe/QTc ratio were measured on resting ECGs. Echocardiographic indices and routine laboratory markers were also recorded. Severe ischemia (>10% LV) was the primary logistic regression outcome. Four hierarchical multivariable models incorporated ECG, clinical, echocardiographic, and laboratory parameters. ROC analyses with DeLong testing evaluated discrimination. RESULTS: Among 1432 patients, 52.4% had <5% ischemia, 27.9% had 5-10%, and 19.7% had >10%. The sQRS-T angle, QTd, Tpe, and Tpe/QTc increased stepwise across ischemia categories (all p < 0.001). In multivariable models, the sQRS-T angle remained an independent predictor of severe ischemia (OR 1.27 per 10° increase, 95% CI 1.16-1.40; p < 0.001). QTd and Tpe/QTc also retained significance, whereas frontal QRS-T angle, QTc, Tpe interval, and P-wave dispersion did not. The sQRS-T angle showed good discrimination (AUC 0.78), and a combined ECG model integrating sQRS-T angle, QTd, and Tpe/QTc improved performance (AUC 0.83; p = 0.008). CONCLUSION: The sQRS-T angle is independently associated with MPS-derived ischemic burden in INOCA. A simple ECG-based model combining dispersion markers provides incremental discriminatory value and may help identify patients with a high ischemic burden who require closer follow-up.
Two distinct ventriculo-atrial relationships during narrow QRS complex tachycardia: What is the mechanism?
Liu R, Gu W, Ma H … +1 more , Xiong N
J Electrocardiol · 2026 · PMID 42143806 · Publisher ↗
A 65-year-old woman underwent ablation for a short RP narrow complex tachycardia (NCT). EP study showed dual AVN phenomenon and two inducible narrow complex tachycardias showing 1:1 VA relationship, concentric atrial act...
A 65-year-old woman underwent ablation for a short RP narrow complex tachycardia (NCT). EP study showed dual AVN phenomenon and two inducible narrow complex tachycardias showing 1:1 VA relationship, concentric atrial activation but different H-A intervals. RV overdrive pacing failed to entrain the first long RP tachycardia (NCT1) but transformed it to another A-on-V tachycardia (NCT2), excluding the diagnosis of AVRT. Premature atrial contractions (PACs) were delivered for further differential diagnosis. During NCT1, a late PAC was able to advance the following His without resetting of the tachycardia. An early PAC terminated the tachycardia with anterograde slow pathway conduction to the His. Both were inconsistent with fast-slow AVNRT and supported AT as the diagnosis. NCT2 was likely to be diagnosed as AVNRT given the A-on-V pattern and the presence of slow pathway. However, His-synchronous PAC advanced the next H over the slow pathway but failed to advance the following A as well as the subsequent H i.e., tachycardia was not reset. All responses to PACs were repeatable, indicating the mechanism of NCT2 was the same AT with anterograde slow pathway conduction to His. The tachycardia was proved to be para-His AT and ablated without difficulty.
Could this intermittent prominent anterior force be a septal fascicle block?
de Campos E Barreiro DT, de Paula Castro LM, de Alencar JN
J Electrocardiol · 2026 · PMID 42143805 · Publisher ↗
BACKGROUND: A septal fascicle of the left bundle branch is an anatomical variant present in a substantial number of human hearts. However, the electrocardiographic features of its block remain controversial. CASE SUMMARY...
BACKGROUND: A septal fascicle of the left bundle branch is an anatomical variant present in a substantial number of human hearts. However, the electrocardiographic features of its block remain controversial. CASE SUMMARY: We describe a case of transitory prominent anterior forces consistent with an intermittent left septal fascicle block, identified on a preoperative ECG of an adult male with a history of diabetes mellitus and systemic hypertension. CONCLUSION: Clinicians should recognize septal fascicular block as an emerging and underrecognized cause of a prominent R-wave in the right precordial leads, particularly when the pattern is intermittent.
The significance of quantitative electrocardiogram analysis in the diagnosis of fulminant myocarditis among pediatric patients.
Guiming Y, Liyun Z, Xiaohui Q … +1 more , Sheng Z
J Electrocardiol · 2026 · PMID 42140005 · Publisher ↗
BACKGROUND: The electrocardiogram (ECG) serves a critical function in the diagnosis of fulminant myocarditis(FM). Nevertheless, the utility of qualitative ECG analysis in diagnosing this condition remains limited. To dat...
BACKGROUND: The electrocardiogram (ECG) serves a critical function in the diagnosis of fulminant myocarditis(FM). Nevertheless, the utility of qualitative ECG analysis in diagnosing this condition remains limited. To date, there is a lack of published studies investigating the application of quantitative electrocardiogram analysis for the diagnosis of FM in pediatric populations. METHODS: We conducted a retrospective cohort study in 79 patients with acute myocarditis (AM). Participants were categorized into FM(26 cases) and non-fulminant myocarditis (NFM) groups(53 cases) according to their clinical manifestations. Comprehensive clinical data and results from auxiliary examinations were systematically gathered. Furthermore, a control group comprising eighty healthy children undergoing routine physical examinations during the same period was included. RESULTS: The FM group demonstrated a significantly higher incidence of ECG abnormalities relative to the NFM group, notably limb lead low voltage trend (LVT) and chest lead LVT(all P < 0.05). Repolarization abnormalities were frequently observed in both the FM and NFM groups. Quantitative ECG analysis revealed that, except for leads III, aVL, aVF, and V1, QRS complex voltage were significantly reduced in the FM group compared to both NFM and control groups (all P < 0.01). Multivariate logistic regression identified prolonged QRS duration and diminished average limb lead voltage as independent predictors of FM. CONCLUSION: Pediatric patients with FM present with pronounced and severe ECG abnormalities. In pediatric patients with myocarditis, prolongation of QRS duration (>98 ms) or reduction in average limb lead voltage(<0.82mv) serve as critical electrophysiological markers for the early diagnosis of FM.
The electrophysiologic continuum of occlusion myocardial infarction.
Gorgels APM
J Electrocardiol · 2026 · PMID 42134254 · Publisher ↗
Acute coronary syndromes used to be classified according to the presence or absence of ST elevation (ST Elevation Myocardial Infarction, STEMI and Non ST Elevation Myocardial Infarction, NSTEMI). The latter contained STE...
Acute coronary syndromes used to be classified according to the presence or absence of ST elevation (ST Elevation Myocardial Infarction, STEMI and Non ST Elevation Myocardial Infarction, NSTEMI). The latter contained STEMI-equivalents, indicating severe ischemia in the setting of critical stenoses in the coronary arteries. To combine both STEMI and STEMI equivalent patterns a new term was coined, i.e. occlusion myocardial infarction (OMI). OMI contains also more recently recognized patterns, among others the Aslanger pattern, South African flag pattern, precordial swirl sign, Northern pattern. Memorizing independent ECG patterns however is difficult and understanding the pathophysiology, leading to ischemic ECG changes, may be more helpful in recognizing acute ischemic syndromes. In the following a unifying system is proposed, combining the different ECG expressions of acute coronary syndromes. It is based on the concept of transmural (endo to epicardial) voltage differences and of the vectorial properties of the electrical activity of the heart. It is realized that the model of the ventricular gradient and ST vector changes during myocardial ischemia, as presented here, is a simplification and will not cover all aspects of the electrical phenomenology in myocardial ischemia and all reported OMI presentations, Nevertheless it may provide a theoretical framework that grounds the OMI concept, and a better oversight of the different ST-T presentations of acute ischemic syndromes.
Time is muscle, context is key: Re-evaluating the urgency of aVR ST elevation.
Paolini F, Brugiatelli L, D'Alfonso A … +2 more , Alfonsi J, Tarsi G
J Electrocardiol · 2026 · PMID 42127701 · Publisher ↗
ST-segment elevation in lead aVR with diffuse ST depression is traditionally associated with left main or three-vessel coronary artery disease in acute coronary syndrome, although its diagnostic specificity remains contr...
ST-segment elevation in lead aVR with diffuse ST depression is traditionally associated with left main or three-vessel coronary artery disease in acute coronary syndrome, although its diagnostic specificity remains controversial. We report a 60-year-old man presenting with chest pain and hemodynamic shock. The ECG showed diffuse ST depression with ST elevation in aVR, prompting urgent activation for coronary angiography. However, physical examination and echocardiography raised suspicion of type A aortic dissection, confirmed by computed tomography. This case highlights that, particularly in the setting of hemodynamic instability, this ECG pattern mandates careful differential diagnosis among the potential causes of coronary hypoperfusion.
What is the ISCE's birthyear as an association and what about its early history?
Abächerli R
J Electrocardiol · 2026 · PMID 42107244 · Publisher ↗
ISCE is an association that organises annual scientific meetings and interactive sessions with regulatory bodies. These sessions are of particular relevance to the electrocardiogram. The paucity of information regarding...
ISCE is an association that organises annual scientific meetings and interactive sessions with regulatory bodies. These sessions are of particular relevance to the electrocardiogram. The paucity of information regarding the history of ISCE is a matter of concern. It is known that the various boards lack a comprehensive or well-founded understanding of the subject. It is imperative to ascertain the precise year of the ISCE's establishment and to provide a concise overview of its early history. For that purpose, a historical investigation was performed, underpinned by interviews with the ISCE's pioneering figures. It was determined that the inaugural meeting pertaining to the Engineering Foundation/ISCE was convened in 1975 in Ringe, New Hampshire. In the subsequent years, the Engineering Foundation continued to provide financial sponsorship for the meeting. The establishment of ISCE in 1984 in the state of California as a non-profit organisation was driven by a commitment to the advancement of electrocardiology through the application of computer methods. In 1989, ISCE achieved full independence. The incorporation of two exceptions in 1977 and 2020 has been demonstrated to exert an influence on the numbering of the annual conferences. Consequently, ISCE celebrated its 40th anniversary as an association in 2024 and its 50th annual conference in 2026.
Evaluation of new vectorcardiography algorithms for identifying left ventricular hypertrophy and impaired systolic function.
Salatzki J, Schwarz AK, Wolfsteller S … +6 more , Hein N, Medina EP, Frey N, Steen H, André F, Passow A
J Electrocardiol · 2026 · PMID 42107243 · Publisher ↗
BACKGROUND: Timely diagnosis of impaired systolic function and left ventricular hypertrophy (LVH) remains a clinical challenge. Routine electrocardiography provides limited diagnostic accuracy for detecting early or subt...
BACKGROUND: Timely diagnosis of impaired systolic function and left ventricular hypertrophy (LVH) remains a clinical challenge. Routine electrocardiography provides limited diagnostic accuracy for detecting early or subtle structural abnormalities. Vectorcardiography (VCG), which captures the spatial and temporal characteristics of cardiac electrical activation and repolarization, may offer a rapid, scalable, and cost-effective alternative for screening structural heart disease. OBJECTIVE: To evaluate the diagnostic performance of VCG for identifying impaired systolic function and left ventricular hypertrophy compared with cardiac magnetic resonance imaging. METHODS: This prospective case-control study included 245 participants undergoing both CMR and VCG. Among 245 participants, 40 had reduced LVEF (<40%) and 208 met CMR criteria for LVH; 34 patients had both conditions. Patients were classified as having impaired systolic function (left ventricular ejection fraction [LVEF] <40%), LVH (indexed left ventricular mass ≥ 55 g/m), or controls with structurally normal hearts. VCG was obtained using a five‑lead system (cardisiography), and signals were processed by an AI algorithm extracting 583 parameters. Diagnostic performance was evaluated using CMR as reference. RESULTS: The repolarization time-difference ratio (Rpeak-Tonset / QRSend-Tpeak) showed the best diagnostic performance for impaired systolic function, with an area under the curve (AUC) of 0.843, sensitivity of 80.0%, and specificity of 83.9%. In LVH patients, three parameters-T-wave azimuth, T-wave magnitude, and azimuth variability-showed AUCs ranging from 0.739 to 0.791. Overall diagnostic accuracy was 81.7% for impaired systolic function and 78.2% for LVH, and 83.1% for the combined phenotype of reduced LVEF and LVH. CONCLUSION: VCG reliably detects left ventricular systolic dysfunction and hypertrophy. This approach offers a scalable and interpretable screening tool, especially valuable in settings with limited access to advanced cardiac imaging. Future multicenter studies are needed to validate these findings and support clinical implementation.
Activation dispersion index as a novel ECG marker for assessing ventricular electrical synchrony: Left bundle branch area pacing versus right ventricular apical pacing in post-TAVI patients with high-grade atrioventricular block.
Demir GG, Gülşen K, Demir S … +3 more , Çelik M, Uslu A, Küp A
J Electrocardiol · 2026 · PMID 42105506 · Publisher ↗
BACKGROUND: Permanent pacemaker implantation is required in approximately 10-25% of patients following transcatheter aortic valve implantation (TAVI) due to complete atrioventricular (AV) block. Conventional right ventri...
BACKGROUND: Permanent pacemaker implantation is required in approximately 10-25% of patients following transcatheter aortic valve implantation (TAVI) due to complete atrioventricular (AV) block. Conventional right ventricular apical (RVA) pacing is known to induce ventricular electrical dyssynchrony, potentially contributing to pacing-induced cardiomyopathy. Left bundle branch area pacing (LBBAP) has emerged as a physiological alternative by recruiting the native conduction system. However, objective electrocardiographic quantification of ventricular synchrony in this population remains underexplored. OBJECTIVES: To evaluate and compare ventricular electrical synchrony between LBBAP and RVA pacing in post-TAVI patients using a novel ECG-based metric - the Activation Dispersion Index (ADI). METHODS: This retrospective, single-center, comparative study included 101 patients who developed high-grade AV block following TAVI and underwent permanent pacemaker implantation (LBBAP: n = 53; RVA pacing: n = 48). Precordial R-wave peak times (RWPT) in leads V1-V6 were measured manually on 12‑lead ECGs using ImageJ software (3 repeated measurements per lead). ADI was defined in two forms: ADI-SD (standard deviation of V1-V6 RWPT values) and ADI-Range (maximum minus minimum RWPT). Pre-pacing (intrinsic rhythm during high-grade AV block) and post-pacing ECGs were analyzed. The primary endpoint was the change in ADI-SD (ΔADI-SD = pre - post). Inter-group comparison was performed using the Mann-Whitney U test; within-group pre-post comparisons used the Wilcoxon signed-rank test. RESULTS: Baseline demographic and clinical characteristics were comparable between groups. Pre-pacing ADI-SD was numerically higher in the LBBAP group (15.3 ± 6.7 vs. 12.5 ± 6.7 ms; p = 0.018). Following pacemaker implantation, LBBAP produced a significant reduction in both ADI-SD (15.3 ± 6.7 to 11.9 ± 4.8 ms; p = 0.001) and ADI-Range (39.4 ± 16.3 to 31.0 ± 13.7 ms; p = 0.001). In contrast, RVA pacing resulted in no significant change in ADI-SD (12.5 ± 6.7 to 12.3 ± 6.0 ms; p = 0.939) or ADI-Range (p = 0.926). Post-pacing ADI values converged between groups (ADI-SD: 11.9 vs. 12.3 ms; p = 0.865). ΔADI-SD was significantly greater in the LBBAP group (3.4 ± 7.0 vs. 0.2 ± 8.8 ms; p = 0.028; Cliff's δ = 0.25; 95% CI for mean difference: 0.11 to 6.35 ms). Post-pacing QRS duration was significantly shorter in the LBBAP group (107.8 ± 22.0 vs. 147.4 ± 19.2 ms; mean difference - 39.6 ms [95% CI -47.6 to -31.6 ms]; p < 0.001; Cliff's δ = -0.81), and within the LBBAP group, shorter post-pacing QRS duration correlated with greater ΔADI-SD (Spearman ρ = -0.34, p = 0.013). CONCLUSIONS: LBBAP significantly reduces ECG-derived ventricular activation dispersion in post-TAVI patients with high-grade AV block, as quantified by the Activation Dispersion Index. RVA pacing does not alter ADI, suggesting persistence of electrical dyssynchrony. ADI represents a simple, reproducible, and non-invasive method for assessing ventricular electrical synchrony and may serve as a surrogate marker for pacing-induced cardiomyopathy risk stratification.
Opposite calcium disorders, similar electrical risk: Reversible cardiomyopathy due to hypocalcemia and Brugada syndrome unmasked by hypercalcemia.
Megid TBC, Ubida C, de Melo Sousa Ferro AC … +6 more , Marchioni DN, Palmegiani E, Silva BMC, Junior LCV, Padovese V, Filho AML
J Electrocardiol · 2026 · PMID 42105505 · Publisher ↗
Calcium plays a fundamental role in cardiac electrophysiology and myocardial, contraction, and disturbances in calcium homeostasis may lead to significant electrical, and mechanical cardiac dysfunction. We report two cli...
Calcium plays a fundamental role in cardiac electrophysiology and myocardial, contraction, and disturbances in calcium homeostasis may lead to significant electrical, and mechanical cardiac dysfunction. We report two clinically opposite but pathophysiologically related cases of calcium imbalance. The first case describes severe hypocalcemia presenting with long QT interval and acute heart failure due to hypocalcemic cardiomyopathy, with complete recovery of ventricular function after calcium correction. The second case describes a young patient with severe hypercalcemia due to primary hyperparathyroidism who presented with syncope, a type 1 Brugada electrocardiographic pattern, and short QT interval. After normalization of calcium levels, the electrocardiographic abnormalities initially resolved; however, recurrent syncope and a type 2 Brugada pattern were later observed under normocalcemia. Pharmacological provocation with ajmaline unmasked a type 1 Brugada pattern, confirming Brugada syndrome. These cases illustrate that calcium disorders may cause significant electrocardiographic changes, reversible myocardial dysfunction, and may unmask latent channelopathies. Recognition of electrolyte abnormalities is essential, as these conditions may be reversible but potentially lifethreatening.
Criss-cross heart electrocardiographic analysis. Bicentric study.
Jesús RF, Carlos GR, Alfredo MS … +3 more , Paola GM, Isabel MV, Pedro IT
J Electrocardiol · 2026 · PMID 42102628 · Publisher ↗
BACKGROUND: Criss-cross is a rare congenital heart disease, of which the electrocardiographic characteristics are not precisely known for early diagnosis. OBJECTIVE: To compare electrocardiographic and echocardiographic...
BACKGROUND: Criss-cross is a rare congenital heart disease, of which the electrocardiographic characteristics are not precisely known for early diagnosis. OBJECTIVE: To compare electrocardiographic and echocardiographic characteristics for the diagnosis of patients with criss-cross heart. METHODS: A retrospective, comparative, cross-sectional study was carried out in two centers over 42 years. The age, sex, and 12‑lead basal electrocardiographic parameters were analyzed. In cases of dextrocardia, right-sided and posterior ECG were performed. Echocardiography was performed to obtain atrial situs, cardiac position, atrioventricular and ventricle arterial relationship, and associated cardiac defects. A descriptive analysis with measures of central tendency was done to assess the age of the population and proportions for the echocardiographic-electrocardiographic characteristics. A statistical analysis was used to find significant differences (p < 0.05) between the ECG and echocardiography groups. RESULTS: Of the 21 patients studied, 14 (66%) were found with situs solitus, 10. (47.6%) with levocardia, 14 (66%) with atrio ventricular concordance, 13 (61.9%) with double outlet right ventricle and 17 (80.9%) with supero-inferior ventricles. The electrocardiogram predicted atrioventricular relationship in 20 cases (95.2%) (p < 0.01) and supero-inferior ventricles in 17 (81%), 15 (71.4%) had a superior QRS axis (82%) (p 0.02). Atrial and ventricular enlargement in the electrocardiogram correlated (p = 0.05) with associated defects in 16 cases (76.1%). CONCLUSIONS: The electrocardiographic analysis of these patients allows us to visualize the situs, position of the cardiac chambers, and associated defects in patients with criss-cross heart. It is useful for the diagnostic orientation of the echocardiographer and therefore contributes initially to the echocardiographic study.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe