Journal Of Electrocardiology[JOURNAL]
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200 papers
Evaluation of repolarization abnormalities with 12-lead ECG and 24-hour Holter ECG monitoring in patients with Duchenne muscular dystrophy.
Didinmez Taşkırdı E, Ünalp A, Yılmaz Ü … +2 more , Meşe T, Yılmazer MM
J Electrocardiol · 2026 · PMID 41616430 · Publisher ↗
BACKGROUND: Duchenne muscular dystrophy (DMD) is an inherited neuromuscular disorder causing progressive degeneration of skeletal and cardiac muscles due to dystrophin deficiency. Cardiac involvement ranges from mild to...
BACKGROUND: Duchenne muscular dystrophy (DMD) is an inherited neuromuscular disorder causing progressive degeneration of skeletal and cardiac muscles due to dystrophin deficiency. Cardiac involvement ranges from mild to severe, including heart failure, arrhythmias, conduction defects, and sudden cardiac death. OBJECTIVE: This study aimed to evaluate early markers of cardiac repolarization abnormalities in DMD patients by analyzing standard 12‑lead ECG parameters-QT interval, corrected QT (QTc), T peak to T end (Tp-e), Tp-e/QT, and Tp-e/QTc ratios-and microvolt T-wave alternans (MTWA) from 24-h Holter monitoring. METHODS: Seventy-four individuals participated: 39 DMD patients and 35 age- and sex-matched healthy controls. Data on demographics, ambulation status, ECG, and Holter recordings were collected and compared. All participants underwent standard 12‑lead electrocardiography and 24-h Holter electrocardiogram monitoring. ECG measurements were performed manually by a blinded operator using standardized techniques. Holter recordings were collected and compared (analyzable data obtained from 33 patients and 34 controls). The QTc interval was calculated using Bazett's formula. Correlation analyses and statistical comparisons between groups were performed using appropriate parametric and non-parametric tests. RESULTS: DMD patients exhibited significantly higher resting heart rates. The Tp-e interval was similar between groups, while the QT interval was significantly shorter in the patient group, the QTc interval showed no significant difference between groups. Tp-e/QT ratio was higher in the patient group; Tp-e/QTc ratios showed no difference. The QTc interval was significantly prolonged in the non-ambulatory DMD group. MTWA values did not differ significantly between groups. Due to the limited sample size and absence of established pediatric reference values, MTWA findings must be considered inconclusive. CONCLUSION: In conclusion, our study reveals subtle repolarization alterations in DMD patients, including elevated resting heart rate and a trend toward increased Tp-e/QT ratio. While these findings do not yet establish a definitive arrhythmic phenotype, they suggest the presence of early electrophysiological changes that may warrant longitudinal cardiac evaluation. Prospective follow-up studies are essential to determine the prognostic significance of these parameters and their relationship to clinical arrhythmic outcomes in the pediatric DMD population.
Prolonged P-wave duration is associated with increased left atrial volume and delayed atrial conduction assessed by electro-anatomic mapping in patients with atrial fibrillation.
Kabutoya T, Makimoto H, Anno K … +10 more , Kurosu YT, Kimura Y, Okuyama T, Watanabe H, Yokota A, Kamioka M, Watanabe T, Komori T, Imai Y, Kario K
J Electrocardiol · 2026 · PMID 41610740 · Publisher ↗
BACKGROUND: Atrial remodeling contributes to atrial fibrillation through structural and electrical alterations. Prolonged P-wave duration indicates conduction delay, while 3D mapping quantifies left atrial (LA) volume an...
BACKGROUND: Atrial remodeling contributes to atrial fibrillation through structural and electrical alterations. Prolonged P-wave duration indicates conduction delay, while 3D mapping quantifies left atrial (LA) volume and conduction time. METHODS: This study enrolled 27 patients with atrial fibrillation (mean age 63 ± 10 years, 18 men) who underwent catheter ablation. Post-ablation 3D mapping was performed to assess atrial conduction time and LA volume. LA volume was also measured by transthoracic echocardiography. Electrocardiograms for analysis were obtained the following day while all patients were in sinus rhythm. Standard 12‑lead ECGs were recorded, and P-wave duration was digitally measured in each lead; the maximum value (Pmax) was used for analysis. Atrial conduction time and LA volume were compared between patients with Pmax ≥140 ms and those with Pmax <140 ms. RESULTS: Pmax was significantly correlated with LA conduction time (R = 0.51, p = 0.016), total atrial conduction time (R = 0.62, p < 0.001), and the LA volume index (R = 0.48, p = 0.034). Patients with Pmax ≥140 ms showed delayed conduction and a larger LA volume index compared with those with Pmax <140 ms (LA conduction time 137.3 ± 41.0 vs. 104.5 ± 19.9, p = 0.010; total atrial conduction time 178.8 ± 40.0 vs. 140.8 ± 24.2, p = 0.007; LA volume index 73.7 ± 8.4 vs. 53.6 ± 16.0 mL/m, p = 0.014). Moreover, Pmax was significantly correlated with the LA volume index measured by echocardiography (R = 0.52, p = 0.013). CONCLUSIONS: Prolongation of Pmax on electrocardiography was significantly associated with delayed atrial conduction and increased LA volume as measured by electro-anatomic mapping.
Optimizing atrial fibrillation detection through ECG feature selection using Extra-Trees and statistical association measures.
Petmezas G, Papageorgiou VE, Passman RS … +4 more , Rogers JA, Stefanopoulos L, Katsaggelos AK, Maglaveras N
J Electrocardiol · 2026 · PMID 41610739 · Publisher ↗
INTRODUCTION: Atrial fibrillation (AFib) is the most prevalent abnormal heart rhythm, significantly increasing the risk of stroke and heart failure. Accurate and timely detection remains challenging, particularly due to...
INTRODUCTION: Atrial fibrillation (AFib) is the most prevalent abnormal heart rhythm, significantly increasing the risk of stroke and heart failure. Accurate and timely detection remains challenging, particularly due to the complexity of 12‑lead electrocardiogram (ECG) interpretation. While machine learning (ML) and deep learning (DL) models have demonstrated high accuracy in AFib detection, selecting the optimal input features is often non-trivial. This study aims to develop a hybrid feature selection methodology that objectively identifies the most discriminative ECG-based features for distinguishing AFib from normal sinus rhythm (NSR). MATERIAL & METHODS: We propose a hybrid framework that combines Extremely Randomized Trees (Extra-Trees) with statistical association measures to identify physiologically meaningful ECG features. Our analysis evaluates morphological, entropy-based and spectral hand-crafted features extracted from 12‑lead ECG recordings of patients who underwent catheter ablation for AFib. Two novel metrics, the feature importance score (FIS) and overall feature importance score (OFIS), are introduced to quantify feature relevance. RESULTS: The proposed approach ranked 97 extracted features and identified the 10 most important per ECG lead and 20 most relevant overall, with high consistency across leads. The interquartile range of RR-intervals achieved the highest normalized OFIS value (0.064), followed by other rhythm-related and entropy-based measures, confirming their strong discriminative power. The dimensionality of the feature space was thus reduced by nearly 80% while preserving interpretability and physiological meaning. CONCLUSIONS: This methodology provides a reproducible, interpretable and statistically grounded framework for ECG-based feature discovery, offering a preprocessing step for ML/DL models and aiding clinicians in real-time AFib detection.
The value of ST-segment deviation in lead aVR for predicting the infarct-related artery in acute inferior STEMI: A systematic review and meta-analysis.
Li YY, Zeng F, Deng J … +8 more , Huang B, Yan GD, Chen XW, Li B, Chen YG, Yang H, Zhao Q, Li L
J Electrocardiol · 2026 · PMID 41581264 · Publisher ↗
BACKGROUND: The infarct-related artery (IRA) in acute inferior wall ST-segment elevation myocardial infarction (inferior STEMI) is predominantly the left circumflex artery (LCX) or the right coronary artery (RCA). Electr...
BACKGROUND: The infarct-related artery (IRA) in acute inferior wall ST-segment elevation myocardial infarction (inferior STEMI) is predominantly the left circumflex artery (LCX) or the right coronary artery (RCA). Electrocardiographic ST-segment deviation in lead aVR has shown potential value in predicting the IRA, but systematic evidence is lacking. METHODS: A comprehensive literature search was undertaken across Web of Science, PubMed, and Scopus to identify relevant studies published until March 2025. Pooled sensitivity and specificity were calculated using a bivariate effects model. Overall accuracy was quantified by the diagnostic odds ratio (DOR) and area under the curve (AUC). RESULTS: Twenty-four studies (6416 participants) were included. For LCX prediction, aVR ST-segment depression (aVR-STD) demonstrated pooled sensitivity of 0.62 (95% CI: 0.51-0.72), specificity of 0.81 (95% CI: 0.75-0.86), and good overall accuracy [DOR = 7.01 (95% CI: 3.72-13.22), AUC = 0.80 (95% CI: 0.76-0.83)]. Conversely, aVR ST-segment elevation (aVR-STE) was a poor predictor for LCX [sensitivity = 0.02 (95% CI: 0.01-0.08), AUC = 0.55 (95% CI: 0.51-0.59)]. For RCA prediction, aVR-STE demonstrated pooled sensitivity of 0.06 (95% CI: 0.03-0.13), specificity of 0.97 (95% CI: 0.93-0.98), and moderate overall accuracy [DOR = 1.99 (95% CI: 1.15-3.43), AUC = 0.75 (95% CI: 0.71-0.79)]. aVR-STD was a poor predictor for RCA [sensitivity = 0.19 (95% CI: 0.13-0.27), AUC = 0.23 (95% CI: 0.19-0.27)]. Heterogeneity analysis identified the ST-segment reference point and smoking history as potential contributors. CONCLUSION: In inferior STEMI, aVR-STD demonstrates significant value in predicting LCX as the IRA, while its accuracy appears moderated by the ST-segment measurement reference point and smoking history. Conversely, aVR-STE shows limited predictive value for RCA.
Malignant arrhythmia risk assessment based on lead-I mobile ECG measurements using machine learning.
Tuboly G, Kiss O, Babity M … +4 more , Zámodics M, Merkely B, Kozmann G, Issa MF
J Electrocardiol · 2026 · PMID 41570464 · Publisher ↗
This paper presents an algorithm capable of estimating malignant arrhythmia risk based on a short lead-I ECG record. We chose the mean and relative standard deviation of beat-to-beat QRST integrals as feature parameters....
This paper presents an algorithm capable of estimating malignant arrhythmia risk based on a short lead-I ECG record. We chose the mean and relative standard deviation of beat-to-beat QRST integrals as feature parameters. The algorithm was trained on a learning set consisting of three subgroups: 55 healthy subjects, 48 patients without malignant arrhythmia history, and 48 malignant arrhythmia patients. These subgroups represented the normal, moderate, and high risk, respectively. The 3 nearest neighbors (3-NN), and the 1-D and 2-D Bayesian classifiers were used as supervised machine-learning techniques. The test set contained ECG signals of 63 healthy subjects and 52 patients with confirmed malignant arrhythmia records. We obtained the best classification results with the 2-D Bayesian classifier, which produced a decision efficiency of 87.30% and 94.23% for the normal and malignant arrhythmia cases, respectively. Slightly lower results were achieved by the 3-NN method (80.95%, 94.23%) and the 1-D Bayesian classifier (77.78%, 94.23%). Considering the QTc parameter instead of the QRST integral produced a relatively low decision efficiency in the malignant arrhythmia case (84.62%). The proposed method performs best with the 2-D Bayesian method, while it is still efficient with the 3-NN classifier. According to our current knowledge, our algorithm is the first one which only requires a single-channel ECG as input and efficiently estimates malignant arrhythmia risk at the same time. As the proposed method relies only on lead-I ECG, it can be very useful in mobile ECG systems (e.g., in WIWE), making out-of-hospital risk assessment possible.
Exercise high-frequency QRS versus exercise stress electrocardiography in diagnosing myocardial ischemia: A meta-analysis.
Wang Z, Wang S, Liu M … +7 more , Li D, Hua J, Kong X, Chen H, Hu H, Gao C, Pan J
J Electrocardiol · 2026 · PMID 41564515 · Publisher ↗
BACKGROUND AND OBJECTS: Exercise stress high-frequency QRS (ES-HFQRS) is a new non-invasive diagnostic technique mainly for myocardial ischemia, which has been demonstrated with favorable diagnostic efficacy in patients...
BACKGROUND AND OBJECTS: Exercise stress high-frequency QRS (ES-HFQRS) is a new non-invasive diagnostic technique mainly for myocardial ischemia, which has been demonstrated with favorable diagnostic efficacy in patients with early ischemic symptoms. Multiple studies confirmed ES-HFQRS's superior diagnostic performance over traditional exercise stress electrocardiography (EST) analysis. However, until now, there is still no meta-analysis that compares the diagnostic efficacy of ES-HFQRS and EST.Therefore, this meta aims to compare the diagnostic value of ES-HFQRS with EST. METHODS: Databases were searched up to August 4, 2025, using keywords including "exercise stress HFQRS" and "exercise stress electrocardiography". Sensitivity and specificity were pooled using a bivariate random-effects model. Summary receiver operating characteristic (SROC) curves were plotted, and the area under the curve (AUC) was calculated. Subgroup analyses and Meta-regression explored sources of heterogeneity. RESULTS: Ten studies involving 3352 patients were included. The pooled sensitivity of ES-HFQRS was significantly higher than that of EST (65% [95% CI: 55%-73%] vs. 37% [95% CI: 29%-45%]; P < 0.001), with no significant difference in specificity (78% [95% CI: 72%-83%] for HFQRS vs. 85% [95% CI: 78%-90%] for EST; P = 0.12). The AUCs of ES-HFQRS and EST were 0.77 and 0.64, respectively. Parallel test combining both methods achieved significantly higher sensitivity than EST alone (76% [95% CI: 69%-82%] vs. 37% [95% CI: 29%-45%]; P < 0.001) while maintaining stable specificity at 64% (95% CI: 58%-70%). The serial test increased specificity to 96% (95% CI: 94%-97%),with a significantly lower sensitivity of 22% (95% CI: 17%-29%). CONCLUSION: ES-HFQRS had superior sensitivity to EST for the non-invasive diagnosis of myocardial ischemia. Combining both analytical methods flexibly could enhance the diagnostic value in the detection of myocardial ischemia.
Beyond STEMI criteria: The electrocardiographic "South African Flag Sign" revealing an isolated proximal ramus intermedius occlusion.
Granata LG, Busà A, Marchetta M … +2 more , Alagna G, Amico F
J Electrocardiol · 2026 · PMID 41548417 · Publisher ↗
The South African Flag Sign (SAFS) is an emerging ECG marker of acute coronary occlusion and a potential STEMI-equivalent, though not yet included in guidelines. It features ST elevation in I-aVL and V2 with reciprocal d...
The South African Flag Sign (SAFS) is an emerging ECG marker of acute coronary occlusion and a potential STEMI-equivalent, though not yet included in guidelines. It features ST elevation in I-aVL and V2 with reciprocal depression in III (and often in additional inferior leads) usually associated with first diagonal branch (D1) occlusion. We report a 66-year-old man with chest pain and SAFS, found to have an isolated sub-occlusive proximal ramus intermedius lesion successfully treated with primary PCI. This case shows that SAFS reflects an occlusion myocardial infarction and serves as a marker of the ischaemic territory rather than a specific culprit vessel, being generated by arteries other than D1 when they share a similar course and perfusion territory. Greater awareness may prevent misclassification and expedite reperfusion therapy.
Unmasking the J-wave: 3D ECG shows terminal depolarization mimicking early repolarization.
Bermejo Valdés AJ
J Electrocardiol · 2026 · PMID 41538973 · Publisher ↗
We used three-dimensional (3D) electrocardiography (ECG) to track the J-wave in V6 through viewing planes inaccessible to standard ECG. Across three identified J-loop phenotypes, we found that the planar morphology of th...
We used three-dimensional (3D) electrocardiography (ECG) to track the J-wave in V6 through viewing planes inaccessible to standard ECG. Across three identified J-loop phenotypes, we found that the planar morphology of the end QRS deflection, whether J-wave or slurring, depended on projection and was interconvertible under rotation. Although traditionally attributed to phase-1 of the action potential, the 3D J-loop showed that the J-wave becomes concealed and occupies depolarization regions in V1. Here, we examine this discrepancy and show that 3D ECG can more accurately reinterpret the electrophysiological and pathological phenomena associated with early repolarization.
Electrocardiographic assessment of ventricular repolarization variables in patients with wild-type transthyretin amyloid cardiomyopathy.
Yenerçağ M, Çoksevim M, Şahin MK … +6 more , Sivri S, Boyaci F, Erdogan G, Öztürk B, Yilmaz M, Yilmaz MB
J Electrocardiol · 2026 · PMID 41518876 · Publisher ↗
INTRODUCTION: Wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) is a progressive infiltrative cardiomyopathy characterized by extracellular deposition of misfolded transthyretin protein. This condition has been...
INTRODUCTION: Wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) is a progressive infiltrative cardiomyopathy characterized by extracellular deposition of misfolded transthyretin protein. This condition has been associated with an increased risk of ventricular arrhythmias. Electrocardiographic repolarization indices such as Tp-e interval and Tp-e/QT ratios are emerging as markers of arrhythmic risk. This study aimed to evaluate ventricular repolarization parameters in ATTRwt-CM patients compared to healthy individuals. METHODS: 95 newly diagnosed ATTRwt-CM patients and 95 age- and sex-matched healthy controls were enrolled between August 2023 and August 2025. Electrocardiographic parameters, including Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios, were measured. Left ventricular mass index (LVMI), left atrial volume index (LAVI), and left ventricular diastolic function parameters were evaluated via echocardiography. RESULTS: The Tp-e interval (81.7 ± 4.6 ms vs. 71.1 ± 5.7 ms; p < 0.001), Tp-e/QT ratio (0.21 ± 0.01 vs. 0.19 ± 0.02; p < 0.001), and Tp-e/QTc ratio (0.18 ± 0.01 vs. 0.17 ± 0.01; p < 0.001) were significantly prolonged in the ATTRwt-CM group. A significant positive correlation was observed between Tp-e indices and LVMI, LAVI, mean E/e' ratio, and NT-proBNP levels. CONCLUSION: Our study showed that Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio, which are evaluated electrocardiographically in patients with ATTRwt-CM, were prolonged compared with normal healthy individuals. A positive correlation was determined between repolarization parameters and markers of myocardial remodeling. We believe that pre-treatment evaluation of repolarization parameters in ATTRwt-CM patients would be beneficial for predicting ventricular arrhythmia risk.
Cumulative electrocardiogram abnormalities predict left ventricular ejection fraction reduction: EchoNext database analysis.
Kim S, Saad B, Chu G
J Electrocardiol · 2026 · PMID 41512645 · Publisher ↗
BACKGROUND: Individual electrocardiographic abnormalities associate with reduced left ventricular ejection fraction (LVEF), but whether multiple continuous ECG parameters provide synergistic predictive value compared to...
BACKGROUND: Individual electrocardiographic abnormalities associate with reduced left ventricular ejection fraction (LVEF), but whether multiple continuous ECG parameters provide synergistic predictive value compared to single parameters or binary scoring remains incompletely characterized. METHODS: QRS duration, PR interval, and heart rate-corrected QT interval (QTc) from ECGs were analyzed in 89,630 paired ECG-echocardiogram studies from the EchoNext database. After systematic evaluation of missing data patterns revealing significant selection bias, the cohort was divided into training (70%, n = 62,741) and validation (30%, n = 26,889) sets using stratified sampling. Seven logistic regression models were developed, all adjusted for age and sex. Models were evaluated using bootstrap confidence intervals with 1000 iterations and 5-fold stratified cross-validation. RESULTS: The full continuous model achieved fair discrimination (AUC 0.710, 95% CI 0.699-0.714) compared to QTc alone (AUC 0.695, ΔAUC = 0.016, p < 0.001). Among individual parameters, QTc demonstrated strongest association (AUC 0.695), followed by QRS duration (AUC 0.673) and PR interval (AUC 0.603). LVEF ≤45% prevalence increased from 15.9% (0 abnormalities) to 30.6% (1 abnormality), 49.5% (2 abnormalities), and 58.3% (3 abnormalities) (Cochran-Armitage Z = 76.0, p < 0.001). At the optimal threshold, the model achieved sensitivity 59.9%, specificity 72.6%, positive predictive value 37.9%, and negative predictive value 86.7%. All models showed excellent calibration slopes (range 0.963-1.043). Cross-validation confirmed stability (CV AUC 0.706 ± 0.006). CONCLUSIONS: Combined continuous ECG parameters provide predictive value for reduced LVEF compared to individual parameters or binary classifications. However, selection bias from non-random missing data (42.0% vs 21.8% outcome prevalence in incomplete vs complete cases, p < 0.001) suggests findings likely underestimate true associations.
Innovative application of six-lead KardiaMobile device in children under three years of age.
Zabłocki J, Warych M, Krawczyk J … +3 more , Herc J, Wieniawski P, Werner B
J Electrocardiol · 2026 · PMID 41512644 · Publisher ↗
The use of the six‑lead AliveCor KardiaMobile (6LACKM) has not been thoroughly evaluated in children under three years of age. This report presents our initial experience with modified 6LACKM ECG acquisition techniques t...
The use of the six‑lead AliveCor KardiaMobile (6LACKM) has not been thoroughly evaluated in children under three years of age. This report presents our initial experience with modified 6LACKM ECG acquisition techniques tailored to this population, including hand-assisted chest placement and adhesive electrodes adaptation, in various patient states and positions. In a prospective study, we aim to assess the feasibility of 6LACKM in this population and compare its diagnostic quality to standard 12‑lead ECG. Our preliminary experience demonstrate that high-quality tracings can be obtained with the proposed approaches, supporting the potential utility of 6LACKM in early pediatric electrocardiographic monitoring.
Fetal R-peak detection using a swin transformer network with dynamic encoding and parallel decoding.
Breesha SR, Vinsley SS, Nisha M
J Electrocardiol · 2026 · PMID 41477914 · Publisher ↗
The FHR Detection employing dynamic encoding and parallel decoding swin transformer-based fetal R-peak detection network (DPSTFR-Net) was developed to address this issue. A cascaded Sparse Low-Rank and Kernel Recursive L...
The FHR Detection employing dynamic encoding and parallel decoding swin transformer-based fetal R-peak detection network (DPSTFR-Net) was developed to address this issue. A cascaded Sparse Low-Rank and Kernel Recursive Least Squares (CSKL) filter is used to pre-process the input signals in order to eliminate high-frequency noise and baseline interference. DPSTFR-Net with adaptive position encoding is used to combine the position information of multiple receptor fields in order to perform the binary classification. Additionally, the parallel decoder's contextual information is used to reduce the impact of incorrectly categorized data points. Accuracy, precision, Mean Average Error (MAE), and other metrics are assessed using the PhysioNet/Computing in Cardiology Challenge database (PCDB) and the abdominal and direct fECG database (ADFECGDB). The proposed approach obtained 97.02 % accuracy, 98.25 % precision, 97.35 % recall, 97.28 % F1-score, 0.10 TNR, 0.55 FPR, and 0.56 MAE on the PCDB dataset. The approach obtained 97.52 % accuracy, 98.25 % precision, 97.05 % recall, 97.28 % F1-score, 0.09 TNR, 0.60 FPR, and 0.66 MAE for the ADFECGDB dataset. The outcomes of the experiment show that the proposed method is capable of effectively estimating FHR from abdominal ECG data. Commercial applications, such as long-term maternal and fetal monitoring systems, can use the proposed paradigm.
The predictive value of fragmented QRS for severe coronary stenosis in patients undergoing coronary CT angiography.
Tusun E, Korucuk N, Çetin M … +1 more , Elmas AN
J Electrocardiol · 2026 · PMID 41468631 · Publisher ↗
BACKGROUND: Coronary artery disease (CAD) is the leading cause of death worldwide. Fragmented QRS (fQRS) has emerged as a new prognostic marker in cardiovascular disease. Coronary computed tomography angiography (CCTA) i...
BACKGROUND: Coronary artery disease (CAD) is the leading cause of death worldwide. Fragmented QRS (fQRS) has emerged as a new prognostic marker in cardiovascular disease. Coronary computed tomography angiography (CCTA) is an effective method to diagnose obstructive CAD. The degree of stenosis determines the severity of the disease. METHODS: A total of 120 patients admitted to the cardiology outpatient clinic with angina pectoris symptoms were included in the study. The fQRS is defined as the presence of an additional R wave, notching of the R wave, notching of the nadir of the S wave in 2 contiguous leads, or the presence of more than one R' wave without a typical bundle branch block. CCTA was performed on patients with low-moderate risk. The patients were divided into two groups based on the presence (Group 1, n = 58 patients) or the absence (Group 2, n = 62 patients) of ≥70 % coronary artery stenosis. RESULTS: The baseline characteristics of the patients were not significantly different. Group 1 had a higher prevalence of DM, hyperlipidemia, smoking, and fQRS compared to Group 2 (p < 0.05, for all). When the subjects were divided into two groups, fQRS (+) and fQRS (-), a statistically significant difference was revealed between the two groups (p < 0.001). A positive correlation was found between fQRS and ≥ 70 % stenosis in CCTA. In the multivariate regression analysis, smoking and fQRS were independent predictors of ≥70 % stenosis in CCTA. CONCLUSION: According to our study, fQRS, an important ECG finding, is associated with ≥70 % stenosis in CCTA and may be evaluated for the prediction of significant coronary stenosis.
Prevalence and clinical relevance of left septal fascicular block following conduction system pacing.
Sahin AT, Keskin O, Kesriklioglu S … +8 more , Moloshova N, Kan H, Kaleli MF, Ozyesil B, Salvarci A, Feyzullayeva L, Sertdemir AL, Gul EE
J Electrocardiol · 2026 · PMID 41468630 · Publisher ↗
BACKGROUND: Left bundle branch area pacing (LBBAP) has emerged as a promising physiological pacing strategy. Due to capture of either posterior or anterior fascicles there might be electrocardiograhic (ECG) changes assoc...
BACKGROUND: Left bundle branch area pacing (LBBAP) has emerged as a promising physiological pacing strategy. Due to capture of either posterior or anterior fascicles there might be electrocardiograhic (ECG) changes associated with it. However, the prevalence and clinical relevance of left septal fascicular block (LSFB) following LBBAP remain poorly understood, with available data limited to isolated case reports. METHODS: This prospective, single-center study included 137 consecutive patients who underwent LBBAP between February 2024 and March 2025. Standard 12‑lead ECGs were obtained at baseline, at 24 h and one month post-implantation, with LSFB defined by established electrocardiographic criteria. Clinical, echocardiographic, biomarker, and procedural data were collected. RESULTS: Mean age was 67.4 ± 12.4 years. LSFB was identified in 40 patients (29 %) and was mostly common in patients with ischemic cardiomyopathy (52.5 % vs. 34.0 %, p = 0.04). Although post-implantation troponin levels showed a significant increase compared to baseline, patients with LSFB had similar level of increase in troponin compared to patients without (∆Troponin 34.3 vs 34.0, p = 0.52). Procedural success rates and pacing parameters were comparable between groups. CONCLUSION: LSFB is a relatively common and clinically relevant finding after LBBAP, strongly associated with ischemic cardiomyopathy. These findings suggest LSFB may represent a marker of underlying ischemic vulnerability and warrant further investigation in larger multicenter cohorts.
Coexistence of three types of Bigeminy with different natures.
Li X, Hu Y
J Electrocardiol · 2026 · PMID 41435745 · Publisher ↗
A 77-year-old female patient had electrocardiographic (ECG) recordings of atrial premature beat (APB) bigeminy, junctional escape-capture bigeminy, and junctional reciprocal beat bigeminy at different time points. This c...
A 77-year-old female patient had electrocardiographic (ECG) recordings of atrial premature beat (APB) bigeminy, junctional escape-capture bigeminy, and junctional reciprocal beat bigeminy at different time points. This case indicates that bigeminy is merely a similar "superficial phenomenon" but arises from distinct underlying mechanisms. Therefore, ECG analysis and diagnosis should not adopt a one-size-fits-all approach; instead, specific conditions require individualized assessment.
Prognostic value of electrocardiographic phenotypes based on conduction intervals and waveform amplitudes in acute anterior myocardial infarction.
Yano M, Egami Y, Kobayashi N … +11 more , Sugino A, Abe M, Ohsuga M, Nohara H, Kawanami S, Ukita K, Kawamura A, Yasumoto K, Okamoto N, Matsunaga-Lee Y, Nishino M
J Electrocardiol · 2026 · PMID 41435744 · Publisher ↗
BACKGROUND: In patients with acute anterior myocardial infarction (MI), abnormalities in conduction intervals and waveform amplitudes observed on admission electrocardiograms may reflect the extent of myocardial damage....
BACKGROUND: In patients with acute anterior myocardial infarction (MI), abnormalities in conduction intervals and waveform amplitudes observed on admission electrocardiograms may reflect the extent of myocardial damage. However, their prognostic significance following percutaneous coronary intervention (PCI) remains incompletely understood. METHODS: We enrolled consecutive patients undergoing emergent PCI for acute anterior MI and performed hierarchical cluster analysis based on P-wave duration (Pd), P-wave amplitude (PWA), PQ interval, QRS duration, and corrected QT interval (QTc). The primary outcome was a composite of heart failure hospitalization and all-cause mortality after PCI, which was compared across the identified phenogroups. RESULTS: A total of 426 patients were included. Optimal cut-off values for Pd, PWA (leads II, V2, and V6), PQ interval, QRS duration, and QTc in predicting the composite outcome were determined via receiver operating characteristic (ROC) curve analysis. Hierarchical clustering identified four distinct electrocardiographic phenotypes: Phenotype 1 ("Normal morphology"), Phenotype 2 ("Low PWA and wide QRS"), Phenotype 3 ("Prolonged Pd/PQ, low PWA, wide QRS, and prolonged QTc"), and Phenotype 4 ("Prolonged Pd/PQ"). Kaplan-Meier analysis revealed that Phenotype 3 was significantly associated with the highest risk of the composite outcome. This phenotype also exhibited the highest prevalence of atrial fibrillation, along with more frequent renal dysfunction and multivessel coronary artery disease, suggesting the coexistence of pre-existing atrial dysfunction and ventricular electrical-structural abnormalities possibly related to ischemia. CONCLUSIONS: In patients with acute anterior MI undergoing PCI, electrocardiographic markers indicative of atrial dysfunction, particularly abnormal P-wave morphology, were significantly associated with adverse clinical outcomes.
Does dispersion of atrial repolarization duration reflect atrial myopathy in left ventricular dysfunction?
Birgün A, Çelik MC, Kalçık M
J Electrocardiol · 2026 · PMID 41435743 · Publisher ↗
Abstract loading — click title to view on PubMed.
Association of P-wave duration with all-cause and cardiovascular mortality in MASHAD cohort study.
Alimi H, Tajik A, Moohebati M … +8 more , Heidari-Bakavoli A, Khavidaki NL, Ghajari A, Ghazizadeh Z, Esmaily H, Ferns GA, Soflaei SS, Ghayour-Mobarhan M
J Electrocardiol · 2026 · PMID 41435742 · Publisher ↗
BACKGROUND AND OBJECTIVE: P wave indices obtained from the electrocardiogram (ECG) serve as indicators of atrial conduction. P-wave duration (PWD) has been associated with various pathological conditions. The relationshi...
BACKGROUND AND OBJECTIVE: P wave indices obtained from the electrocardiogram (ECG) serve as indicators of atrial conduction. P-wave duration (PWD) has been associated with various pathological conditions. The relationship between this factor and cardiovascular mortality remains insufficiently explored. To ascertain the association of PWD and cardiovascular and all-cause mortality in the MASHAD cohort study population. METHOD: Participants were recruited from the Mashhad Stroke and Heart Atherosclerotic Disorder (MASHAD) cohort study. Participants' demographic information were recorded by checklist. Additionally, a comprehensive medical history was collected to identify cardiovascular risk factors, and history of pre-existing cardiovascular disease (CVD). A 12‑lead electrocardiogram (ECG) was obtained from the participants and they were subsequently categorized into two groups based on their PWD (≥ 120 msec and < 120 msec). All participants were followed for a minimum of 10 years for mortality assessment. We employed Cox regression to evaluate the relationship between PWD and cardiovascular and all-cause mortality. In order to evaluate the incremental predictive value of P wave duration, we calculated the net reclassification improvement (NRI) and integrated discrimination improvement (IDI) at 10-year follow-up timepoint. Subsequently, we developed Kaplan-Meier plots, time-dependent ROC curves, and restricted cubic splines (RCS) to thoroughly evaluate the association between PWD and cardiovascular mortality. Subgroup analysis was conducted to evaluate the impact of PWD across various distinct groups. RESULTS: A total of 8885 participants were enrolled in the study. Prolonged PWD was associated with higher all-cause, cardiovascular mortality in unadjusted model. After controlling for covariates, PWD remained significantly associated with all-cause and cardiovascular mortality in continuous form of it. However, PWD in categorical form did not show significant association with cardiovascular mortality. The addition of P wave duration to the conventional model did not provide statistically significant improvement in risk reclassification or discrimination for either all-cause or cardiovascular mortality. The RCS models indicated that the PWD displayed a positive linear correlation with the risk of all-cause mortality across all models. The time-dependent ROC curve demonstrated favorable predictive performance for the adjusted models at both the 5-year and 10-year timepoints. The subgroup analysis revealed no interaction among the subgroups in our statistically significant multivariable models (all p for interaction >0.05). CONCLUSION: Continuous P-wave duration predicted all-cause and cardiovascular mortality, whereas the conventional 120 ms cut-off showed limited prognostic utility.
Electrocardiographs before 1910: Manufacturers and surviving instruments.
Pahlm O, Uvelius B, Widell A
J Electrocardiol · 2026 · PMID 41429077 · Publisher ↗
BACKGROUND: Early electrocardiograph predates electronic amplification and therefore required innovative and highly sensitive instrumentation. Willem Einthoven's introduction of the string galvanometer in 1903 enabled re...
BACKGROUND: Early electrocardiograph predates electronic amplification and therefore required innovative and highly sensitive instrumentation. Willem Einthoven's introduction of the string galvanometer in 1903 enabled recording of clinically useful electrocardiograms and established electrocardiography as a diagnostic method. OBJECTIVES: To describe the provenance and technical features of a uniquely complete string-galvanometer system preserved in Lund, Sweden, and to review early commercial production and surviving string galvanometers manufactured before 1910. METHODS: The Lund electrocardiograph was examined and compared with historical photographs, documentation from Einthoven's laboratory, archival sources, and contemporary literature. Museum and institutional collections as well as manufacturers' records were surveyed for surviving old instruments. RESULTS: The Lund string galvanometer electrocardiograph, constructed in 1909 from Einthoven's original drawings, retains its optical, magnetic coil system, cooling, and recording components and closely matches documented laboratory models. Only two companies produced string galvanometers commercially by then: Professor Max Th. Edelmann's Physikalisch-mechanisches Institut (Munich, Germany) and the Cambridge Scientific Instrument Company (Cambridge, England). Cambridge sold only 14 devices before 1910, and no complete instrument is known to have survived; Edelmann's production is poorly documented, with only few examples preserved. CONCLUSIONS: Intact electrocardiographs from the earliest period of electrocardiography are extremely rare. The Lund instrument represents one of the best-preserved surviving complete devices and underscores the importance of documenting and conserving early biomedical technology.
Electrocardiographic criteria and algorithms to identify the culprit artery in inferior wall infarction. Back to the basics.
Gorgels APM
J Electrocardiol · 2026 · PMID 41411803 · Publisher ↗
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