BACKGROUND: Electrocardiography (ECG) provides valuable information for early diagnosis of myocardial infarction. It is known that the atria receive their blood supply primarily from branches originating from the proxima...BACKGROUND: Electrocardiography (ECG) provides valuable information for early diagnosis of myocardial infarction. It is known that the atria receive their blood supply primarily from branches originating from the proximal segments of the coronary arteries. This study aimed to evaluate whether P wave parameters on admission ECG can help determine proximal versus distal right coronary artery (RCA) occlusion in patients presenting with inferior myocardial infarction (IMI). METHODS: We retrospectively analyzed consecutive patients presenting with IMI to the emergency department between October 2022 and May 2023. After applying exclusion criteria, a total of 123 patients were included. Admission ECG parameters were analyzed in relation to the angiographically confirmed site of coronary occlusion. RESULTS: The study population was divided into two groups according to proximal or distal RCA occlusion. Demographic characteristics were similar between groups. Statistically significant differences were observed between groups in the following ECG parameters: QT dispersion, P wave terminal force, P wave peak time in leads V1 and V2, and ST elevation in lead V1. In multivariable logistic regression analysis, ST elevation in lead V1 (OR 6.1; 95 % CI: 1.48-26.8; p = 0.013) and P wave peak time in lead V1 (OR 1.08; 95 % CI: 1.01-1.12; p = 0.008) were identified as independent predictors of proximal RCA occlusion. A added variable plot demonstrated that P wave peak time > 56 ms was significantly associated with increased probability of proximal coronary occlusion. CONCLUSION: In patients presenting with inferior myocardial infarction, P wave peak time in lead V1 on admission ECG may serve as a useful, non-invasive marker in predicting proximal RCA occlusion.
AIMS: Many people died or were injured in two consecutive huge earthquakes in Turkey in February 2023. The earthquakes caused serious psychiatric disorders including post-traumatic stress disorder (PTSD). This study aime...AIMS: Many people died or were injured in two consecutive huge earthquakes in Turkey in February 2023. The earthquakes caused serious psychiatric disorders including post-traumatic stress disorder (PTSD). This study aimed to compare various electrocardiography (ECG) parameters including fragmented QRS (fQRS) and complete blood count (CBC) parameters including basophil to lymphocyte ratio (BLR) of earthquake-exposed with and without post-traumatic stress disorder (PTSD) subjects. METHODS: ECG and CBC parameters were obtained from 47 earthquake-exposed with PTSD subjects and 51 earthquake-exposed without PTSD subjects. Additional psychiatric and general medical conditions that might affect ECG and CBC were excluded. The PTSD severity scale (PCL-5) and the Symptom Checklist-90-Revised (SCL-90-R) were used. RESULTS: Gender, age, education level, marital and smoking status, PTSD history, location at the time of earthquakes, and residence damage were similar between groups (p > 0.05). The SCL-90-R score of the earthquake-exposed with PTSD group was higher than the earthquake-exposed without PTSD group (p < 0.001). The fQRS count (p = 0.041), presence of fQRS (p = 0.024) and frontal QRS-T angle (p = 0.004) were significantly higher in the earthquake-exposed with PTSD group. This significance persisted for frontal QRS-T angle (adjusted p = 0.049) after controlling for the effects of age, gender, smoking status, post-earthquake migration, and body mass index (BMI) as covariance. After controlling for the effect of age, gender, and BMI in the earthquake-exposed with PTSD group, a significant correlation was detected between fQRS count and PCL-5 (r = 0.764, p < 0.001). The area under the ROC curve of basophil count was 0.857 (p < 0.001; 95 % CI (0.779-0.936)). In the binary logistic regression analysis, BLR contributed significantly to the model (p < 0.001). CONCLUSIONS: This study suggests that there may be significant differences between surface ECG and CBC parameters of individuals with and without earthquake-related PTSD.
Electrocardiogram (ECG) signal compression is paramount in continuously monitoring cardiac patients, as it reduces data storage and transmission costs. Deep neural networks, particularly autoencoders, offer significant p...Electrocardiogram (ECG) signal compression is paramount in continuously monitoring cardiac patients, as it reduces data storage and transmission costs. Deep neural networks, particularly autoencoders, offer significant potential for compressing ECG signals by mapping them to lower-dimensional spaces. This paper presents a novel multichannel convolutional autoencoder model designed to compress ECG signals efficiently. The proposed approach encodes the ECG signal into a four-channel lower-dimensional space using a convolutional encoder, which is subsequently reconstructed by a deconvolutional decoder. Unlike traditional autoencoder-based methods, the first channel in the model remains unconstrained, while increasing levels of sparsity constraints are imposed on the remaining channels. Different quantization levels are applied to each channel to optimize compression further, reflecting the varying numerical ranges caused by the sparsity constraints. The quantized channels are then encoded using Huffman coding, resulting in a higher compression ratio. The model's effectiveness is evaluated on a popular benchmark dataset, using normalized percent root mean square difference (PRDN) error and compression ratio as performance metrics. The proposed method achieves an average compression ratio of 20.23:1, with an average PRDN error of 9.86%, demonstrating its capability to compress ECG signals efficiently while maintaining reconstruction accuracy.
We present a case of a pre-adolescent girl with mitral stenosis caused by rheumatic fever. The 12‑lead ECG showed prolonged P-wave duration indicating interatrial block. In addition, the P waves in the inferior leads sho...We present a case of a pre-adolescent girl with mitral stenosis caused by rheumatic fever. The 12‑lead ECG showed prolonged P-wave duration indicating interatrial block. In addition, the P waves in the inferior leads showed a transient atypical interatrial block with a triphasic pattern in lead II. The appearance of the atypical interatrial block resulted in the attenuation of the P terminal force in lead V1. Atypical interatrial block is associated with atrial cardiomyopathy and is a potential risk factor for atrial fibrillation or stroke.
Pathogenic CACNA1C variants are associated with long QT syndrome, cardiac conduction disorders (CCD), short QT or Brugada syndromes, sudden cardiac death, and rarely hypertrophic cardiomyopathy. Neonatal complete AV bloc...Pathogenic CACNA1C variants are associated with long QT syndrome, cardiac conduction disorders (CCD), short QT or Brugada syndromes, sudden cardiac death, and rarely hypertrophic cardiomyopathy. Neonatal complete AV block (CAVB) has not been previously reported in patients with CACNA1C-mutations. We present a neonate with CAVB, severe heart failure, and non-compaction cardiomyopathy, found to have a de novo, likely pathogenic, heterozygous CACNA1C variant and heterozygous variants of uncertain significance (VUS) in TNNI3K, GATA6, and PDHK1 genes. This case expands the CACNA1C-associated phenotype to include neonatal CAVB and suggests a potential oligogenic contribution to severe neonatal cardiac disease.
BACKGROUND: Electrocardiographic (ECG) "left ventricular hypertrophy (LVH) criteria" are widely used as surrogates for increased LV mass but show limited sensitivity. We evaluated their diagnostic performance against car...BACKGROUND: Electrocardiographic (ECG) "left ventricular hypertrophy (LVH) criteria" are widely used as surrogates for increased LV mass but show limited sensitivity. We evaluated their diagnostic performance against cardiac magnetic resonance (CMR) in a large population cohort. METHODS: We analyzed 4849 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) with standardized digital 12‑lead ECGs and CMR-derived LV mass indexed to body surface area (LVMi). LVH was defined as LVMi >91 g/m (men) and > 77 g/m (women). We assessed Sokolow-Lyon, Cornell voltage, Cornell product, Peguero-Lo Presti, Sokolow-aVL, and MESA-LVH (SV1 + SV2 + RV5). Diagnostic accuracy was calculated for classic ("pre-specified") thresholds and for cutoffs optimized by the Youden index. We also tested whether combining indices via elastic-net penalized logistic regression improved discrimination. RESULTS: LVH prevalence was 30.2 %. Across classic thresholds, sensitivities were very low (3.7-15.2 %) with high specificities (>94 %); likelihood ratios were modest (typical LR+ <4; LR- ≈ 0.89-0.96). Youden-optimized cutoffs improved sensitivity (48.9-64.8 %) at the expense of specificity (54.4-74.3 %), yielding weak LR+ (1.42-1.94) and LR- (0.64-0.71). Pooled area under the ROC curve (AUC) for individual indices ranged 0.62-0.66. An elastic-net model combining all indices did not enhance discrimination beyond the best single measure (AUC 0.646). CONCLUSIONS: In MESA, ECG voltage criteria-whether applied at classic or optimized thresholds-show poor diagnostic performance for CMR-defined LVH. Aggregating indices provides no material gain. These findings support reframing voltage positivity as an amplitude-based electrical phenotype with prognostic value rather than a reliable diagnostic surrogate for structural hypertrophy. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT00005487.
A 68-year-old woman developed delayed QT prolongation and Torsades de Pointes (TdP) following electrical cardioversion for atrial fibrillation. Despite early discontinuation of Sotalol and optimal electrolyte replacement...A 68-year-old woman developed delayed QT prolongation and Torsades de Pointes (TdP) following electrical cardioversion for atrial fibrillation. Despite early discontinuation of Sotalol and optimal electrolyte replacement, she experienced bradycardia-associated TdP approximately 66 h post-cardioversion, requiring resuscitation and temporary overdrive pacing. QTc normalised with pacing, and no further episodes occurred. This case highlights a vulnerable window for proarrhythmia in the days following cardioversion, particularly in patients with multiple QT-prolonging risk factors. Extended ECG monitoring and consideration of early pacing may be critical in preventing life-threatening arrhythmias in high-risk individuals.
The pre-excited complex may be observed with conduction over the NV, AV, NF, or AF pathways. FV-AP are extremely rare preexcitation variants which have distinctive ECG and electrophysiological features. These fibers take...The pre-excited complex may be observed with conduction over the NV, AV, NF, or AF pathways. FV-AP are extremely rare preexcitation variants which have distinctive ECG and electrophysiological features. These fibers take off from the His bundle and the fascicles to the superoseptal location (right ventricular anteroseptum or midseptum). Therefore, they show overlapping characteristics with both anteroseptal and mid-septal AV-AP on surface ECG. These pathways should be ruled out from classical AV-APs before attempting catheter ablation, as FV-APs do not participate in the AVRT circuit and are not associated with rapid antegrade conduction.
INTRODUCTION: Tpeak-Tend interval (Tpe) is considered to be an ECG reflection of the dispersion of repolarization (DOR), and as such has been proposed as a predictor of arrhythmias. In ischemia, robustness of the Tpe-DOR...INTRODUCTION: Tpeak-Tend interval (Tpe) is considered to be an ECG reflection of the dispersion of repolarization (DOR), and as such has been proposed as a predictor of arrhythmias. In ischemia, robustness of the Tpe-DOR relationship may suffer from variability of the myocardium at risk (MaR) area. In the present study, we evaluated the contribution of DOR and MaR to single‑lead and multi‑lead Tpe durations. METHODS: Ischemia was induced by 40-min proximal or distal ligations of the left anterior descending coronary artery in 27 anesthetized pigs. In 48 intramyocardial leads, end of repolarization times (RTs) were determined as the instant of dV/dt max during T-wave, and DOR was calculated as the difference between RTmax and RTmin. In standard 12‑lead ECGs, we determined a single‑lead Tpe (maximal value throughout all leads) and a multi‑lead Tpe as the difference between the earliest Tpeak and latest Tend throughout all leads. MaR was assessed by postmortem Evans blue staining. RESULTS: During 40-min ischemia, DOR and Tpe increased concurrently, but DOR was greater than Tpe at all time-points, especially during ischemia. In univariate linear regression analysis, maximal DOR during occlusion was significantly associated with maximal multi‑lead Tpe, but was not associated with single‑lead Tpe. MaR was significantly associated with maximal single‑lead Tpe, but not with multi‑lead Tpe or DOR. CONCLUSION: Both multi‑lead and single‑lead Tpe underestimated DOR, especially at ischemia. Variation of the size of the ischemic region appeared to be an important factor in evaluating the single‑lead Tpe interval.
A 40-year-old male presented with recurrent paroxysmal palpitations, with one episode of pre-excited atrial fibrillation, and was put on Flecainide 50 mg twice a day elsewhere. Because of recurrent symptoms, he was keen...A 40-year-old male presented with recurrent paroxysmal palpitations, with one episode of pre-excited atrial fibrillation, and was put on Flecainide 50 mg twice a day elsewhere. Because of recurrent symptoms, he was keen on an electrophysiological study (EPS) while on drug therapy. The electrocardiogram (ECG) before drug therapy and the presentation ECG on drug therapy had right and left bundle block morphology, respectively. He had a structurally normal heart without any specific cardiac comorbidities.
A routine electrocardiogram revealed unexpected axis deviations. However, a repeat ECG with careful electrode placement yielded a different tracing. This report highlights how a seemingly routine technical error can prof...A routine electrocardiogram revealed unexpected axis deviations. However, a repeat ECG with careful electrode placement yielded a different tracing. This report highlights how a seemingly routine technical error can profoundly alter ECG interpretation and clinical decision-making.
OBJECTIVES: To assess the link between MB and ECG changes, as well as its association with arrhythmias such as atrial fibrillation (AF) and ventricular tachycardia/fibrillation (VT/VF) in various clinical contexts. METHO...OBJECTIVES: To assess the link between MB and ECG changes, as well as its association with arrhythmias such as atrial fibrillation (AF) and ventricular tachycardia/fibrillation (VT/VF) in various clinical contexts. METHODS: A thorough electronic search was conducted across PubMed Central, Scopus, EMBASE, and reference lists of relevant publications from 1960 up to 30 November 2024. RESULTS: A total of 20 articles met the eligibility criteria for inclusion in this study. Among the 26,932 individuals analysed, 12,152 had MB. The most frequently reported outcomes in the included studies were VT/VF (45 %), followed by ST-segment changes (30 %), AF (25 %), and repolarization abnormalities (15 %). Only studies involving high-risk populations, including patients with intermediate to high risk of CAD (50 %), hypertrophic cardiomyopathy (HCM) (30 %), and 20 % from other clinical settings, had sufficient data for meta-analysis. The pooled analyses found no statistically significant associations between MB and AF (OR 1.170, P = 0.601) or ECG repolarization abnormalities (OR 1.538, P = 0.523). On the other hand, there was a significant association between MB and ST-segment changes (OR 3.467, 95 %CI: 1.549-7.761, P = 0.002) and VT/VF (OR 3.166, 95 %CI: 1.418-7.071, P = 0.001). In patients with HCM, the pooled OR for VT/VF risk was 4.662 (95 % CI: 1.216-17.864, P = 0.025), while in patients with intermediate to high risk CAD, it was 1.700 (95 % CI: 0.260-11.128, P = 0.580). CONCLUSION: MB appears to be significantly associated with ventricular arrhythmias and ST-segment changes, particularly in high-risk clinical populations. However, these findings may not be generalizable to the broader population or to asymptomatic MB cases.
We present a patient case with anterior ST-elevation myocardial infarction (STEMI) with false double heart rate counting caused by computer error. Double counting heart rate typically indicates severe hyperkalemia (Littm...We present a patient case with anterior ST-elevation myocardial infarction (STEMI) with false double heart rate counting caused by computer error. Double counting heart rate typically indicates severe hyperkalemia (Littmann sign). However, this case highlights that Littmann sign may also be seen in acute ST-elevation MI (STEMI) due to peaked T-waves.
Cardiovascular diseases (CVDs) are the most widespread cause of death across the world, and this aspect requires a better risk stratification method. Effectively, this paper tests the potential of the artificial intellig...Cardiovascular diseases (CVDs) are the most widespread cause of death across the world, and this aspect requires a better risk stratification method. Effectively, this paper tests the potential of the artificial intelligence (AI)-predicted electrocardiogram (ECG) age as a novel CVD risk predictor biomarker. We used the CODE-15 % data (over 344,000 ECG records with clinical annotation) to create a logistic regression model that incorporated age predicted from ECG, as well as demographic and comorbidity variables, to evaluate cardiovascular outcomes. The model performed better with ECG-predicted age than using chronological age alone, with a 92 % receiver operating characteristic curve area (AUROC) for atrial fibrillation (AF) detection, compared to 88 % when chronological age was used alone. From the results, the ECG-predicted age showed a stronger correlation with AF (r = 0.17), bundle branch blocks (r = 0.14), and Chagas disease (r = 0.074) than chronological age. Sex-specific patterns were also observed; male sex had an increased risk of sinus bradycardia (odds ratio [OR]: 3.090), while female sex had a lower risk of having a left bundle branch block (LBBB) OR: 0.885) with the variable of ECG-predicted age. These results demonstrate how ECG-predicted age may be used as a biologically meaningful indicator for cardiovascular risk assessment. This study advances personalized medicine by offering a cost-effective and scalable method for detecting CVD, particularly in under-resourced regions that lack conventional biomarkers.
Unexplained LVH commonly prompts a diagnosis of hypertrophic cardiomyopathy (HCM), a sarcomeric protein gene disorder. While ventricular preexcitation is more frequently observed in patients with HCM its presence in a yo...Unexplained LVH commonly prompts a diagnosis of hypertrophic cardiomyopathy (HCM), a sarcomeric protein gene disorder. While ventricular preexcitation is more frequently observed in patients with HCM its presence in a young patient with an HCM phenocopy should raise suspicion for an underlying storage, metabolic, or syndromic condition.