Highlights from the Journal of Electrocardiology
The Journal of Electrocardiology is the official journal of the ISE. In each (bi-monthly) issue of the journal, the editor in chief selects two articles to be highlighted here. The publisher ensures that these articles are open-access.volume 68, September/October 2021
This edition's highlighted articles are:
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Evaluation of
the Seattle and International Criteria in elite Nigerian athletes
by Tochukwu F. Ilodibia and James O. Odia
- The early repolarization pattern is thought to be common in athletes and in black men, but had not yet been studied systematically in black athletes. This study confirmed that ERP is highly prevalent in black men, athletes or not, and rare in black women. ERP incidence did not differ significantly between athletes and non-athletes. However, dome-shaped ST-segment elevation with T-wave inversion was more prevalent in male athletes and their heart rate was lower than in non-athletes.
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Representation
matters: The importance of obtaining diverse ECG normative data from non-Caucasian athletes
by Mustafa Husaini, Elizabeth H. Dineen, and Jordan M. Prutkin- This review paper discusses the above study by Ilodibia and Odia. The authors stress the fact that current criteria to estimate arrhythmia risk in athletes are tailored to a caucasian population and do not work well in black athletes. They welcome the normative ECG screening data provided by Ilodibia and Odia and call for risk stratification studies in different non-caucasian populations.
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Electrocardiographic
left ventricular strain pattern, ST-segment depression and atrial fibrillation at the time of
diagnosis of systemic light chain amyloidosis: Incidence and clinical significance
by Rusnė Jakaitė, Valdas Pečeliūnas, Sigita Aidietienė, Agnė Bertašiūtė, ... Jūratė Barysienė- ECG LV strain pattern is known to accurately reflect replacement fibrosis in aortic stenosis and hypertensive cardiomyopathy.
- ECG LV strain pattern and its components were evaluated in leads I, aVL, V1-V6.
- ST-segment depression and AF were not significantly associated with reduced survival in AL amyloidosis.
- The importance of replacement fibrosis in light chain amyloidosis is still unclear.
volume 67, July/August 2021
This edition's highlighted articles are:
- Effects of permanent
cardiac pacing on ventricular repolarization when compared to cardioneuroablation
by Tolga Aksu, Mohit Turagam, Sandeep Gautam, Piotr Futyma, ... Rakesh Gopinathannair
- For the first time, the effects of ganglionated plexus ablation (group 1) and cardiac pacing (group 2) on ventricular repolarization was compared.
- While ganglionated plexus ablation reduces corrected QT levels, pacing has no effect on ventricular repolarization.
- Expanding a single‑lead
mobile electrocardiographic device to multiple‑lead recordings improves diagnostic accuracy and confidence
by Joey Junarta, Daniel R. Frisch, Sean Dikdan, Max Weiss, ... Kumar Sarkar
- ECG abnormalities are not easily diagnosed by single lead mobile ECG tracings.
- Uncomplicated modifications can expand these devices to record multi-lead tracings.
- This increases the device's diagnostic capability in a wider range of conditions.
volume 66, May/June 2021
This edition's highlighted articles are:
- A new electrocardiographic concept: V1-V2-V3 are
not only horizontal, but also frontal plane leads.
by Laszlo Littmann- Highlights: This review highlights the significance of recognizing V1-V2-V3 as not only horizontal but also as frontal plane leads. Appreciation of this phenomenon helps elucidate a colorful variety of clinically important but seemingly bizarre ECG manifestations that could not be explained otherwise.
- Quantifying
the spatiotemporal influence of acute myocardial ischemia on volumetric conduction velocity
by Wilson W. Good, Brian Zenger, Jake A. Bergquist, Lindsay C. Rupp, ... Rob S. MacLeod- Highlights: Ischemia is known to influence the ST and repolarization phases of the ECG, but it also has a marked effect on propagation (QRS); however, studies investigating propagation during ischemia have been limited. The authors estimated conduction velocity (CV) and ischemic stress prior to and throughout 20 episodes of experimentally induced ischemia in order to quantify the progression and correlation of volumetric conduction changes during ischemia. They found that acute ischemia induces significant conduction slowing, reducing the global median speed by 20 cm/s and observed a biphasic response in CS (acceleration then deceleration) early in some ischemic episodes. They also noted a high temporal correlation between ST-segment changes and CS slowing; however, when comparing these changes over space, they found only moderate correlation (corr. = 0.60).
volume 64, Jan/Feb 2021
This edition's highlighted articles are:
- Prevalence of major and minor electrocardiographic abnormalities in one million primary care Latinos.
by Maíra Silva, Daniel Palhares, Leonardo Ribeiro, Paulo Gomes, ... Milena Marcolino- Highlights: The authors aimed to assess the prevalence of electrocardiographic abnormalities based on the Minnesota code from a large sample of 1.01 m adult Brazilian primary care patients and to evaluate its association with age, sex, and cardiovascular risk factors. Major electrocardiographic abnormalities were observed in 20.2% of adults and 43.1% of elderly patients, and minor abnormalities were found in 46.0% 39.4%, respectively. For adult patients, the number and percentage of major abnormalities rise depending on the number of cardiovascular risk factors.
- Fusion pacing in patients with right bundle branch block who undergo cardiac resynchronization therapy
by Ahmed AlTurki, Pedro Y. Lima, Alejandro Vidal, Bruno Toscani, ... Vidal Essebag- Highlights: The authors aimed to assess whether patients with RBBB respond to CRT with biventricular fusion pacing. They included 8 consecutive patients with RBBB (group 1) who were able to undergo SyncAV programming and 16 patients with RBBB (group 2) from a historical cohort. CRT programed to allow biventricular fusion pacing significantly improved electrical synchrony and LVEF in patients with RBBB. Larger studies are required to confirm these findings.
volume 62, September/October 2020
This edition's highlighted articles are:
- Long-term outcome of pre-specified ECG patterns in acute coronary syndrome
by Kimmo Koivula, Kaari K. Konttila, Markku J. Eskola, Mika Martiskainen, ... Kjell C. Nikus- Highlights: The authors sought to survey the 10-year outcome of pre-specified ECG patterns in ACS patients admitted to a university hospital. The 1184 patients with ACS from 10 years were classified according to nine pre-specified ECG categories: 1) ST elevation; 2) pathological Q waves without ST elevation; 3) left bundle branch block (LBBB); 4) right bundle branch block (RBBB) 5) left ventricular hypertrophy (LVH) without ST elevation except in leads aVR and/or V1; 6) global ischemia ECG (ST depression ≥0.5 mm in 6 leads, maximally in leads V4–5 with inverted T waves and ST elevation ≥0.5 mm in lead aVR); 7) other ST depression and/or T wave inversion; 8) other findings and 9) normal ECG. They found that LBBB, ECG-LVH, global ischemia, and Q waves were associated with worse outcome than a normal ECG, RBBB, ST elevation, or ST depression with or without associated T-wave inversion. LBBB was associated with the highest mortality rates.
- Highlights: The authors sought to survey the 10-year outcome of pre-specified ECG patterns in ACS patients admitted to a university hospital. The 1184 patients with ACS from 10 years were classified according to nine pre-specified ECG categories: 1) ST elevation; 2) pathological Q waves without ST elevation; 3) left bundle branch block (LBBB); 4) right bundle branch block (RBBB) 5) left ventricular hypertrophy (LVH) without ST elevation except in leads aVR and/or V1; 6) global ischemia ECG (ST depression ≥0.5 mm in 6 leads, maximally in leads V4–5 with inverted T waves and ST elevation ≥0.5 mm in lead aVR); 7) other ST depression and/or T wave inversion; 8) other findings and 9) normal ECG. They found that LBBB, ECG-LVH, global ischemia, and Q waves were associated with worse outcome than a normal ECG, RBBB, ST elevation, or ST depression with or without associated T-wave inversion. LBBB was associated with the highest mortality rates.
- Electrocardiogram interpretation in college athletes: Local institution versus sports cardiology center interpretation
by Bradley J. Petek, Jonathan A. Drezner, Jordan M. Prutkin, David S. Owens, ... Kimberly G. Harmon- Highlights: Electrocardiogram (ECG) screening in athletes enhances the detection of conditions associated with sudden cardiac death (SCD), but concerns remain for false positive results when conducted outside of specialized centers. This study compared ECG interpretation in college athletes between local physicians and a sports cardiology center (SCC). The authors conducted ECG screening in athletes from eight Pacific-12 Conference institutions between 2010 and 2016. Local interpretation was compared to SCC interpretation using both the Seattle Criteria (SCC-SC) and the International Criteria (SCC-IC). There was a 97.5% ECG interpretation agreement and substantial interobserver reliability (k = 0.611, p < .001) between local and SCC-SC interpretation in athletes screened starting one year after publication of the Seattle Criteria (n = 1388). Both local and SCC physicians correctly identified six abnormal ECGs associated with conditions at risk of SCD. ECG interpretation by local physicians at college universities had similar accuracy compared to a specialized SCC.
volume 61, July/August 2020
This edition's highlighted articles are:
- Identifying the most important ECG predictors of reduced ejection fraction in patients with suspected acute coronary syndrome
by Mohammad Alhamaydeh, Richard Gregg, Abdullah Ahmad, Ziad Faramand, ... Salah Al-Zaiti- Highlights: The authors sought to identify ECG features that are most predictive for real-time screening of reduced left ventricular ejection fraction (LVEF) in the acute care setting. To this end, they performed a secondary analysis of a prospective, observational cohort study of patients evaluated for suspected acute coronary syndrome. They concluded that poor R wave progression in precordial leads with dominant QS pattern in V3 is the most predictive feature of reduced LVEF in suspected ACS. This feature constitutes a simple visual marker to aid clinicians in identifying those with impaired cardiac function.
- Highlights: The authors sought to identify ECG features that are most predictive for real-time screening of reduced left ventricular ejection fraction (LVEF) in the acute care setting. To this end, they performed a secondary analysis of a prospective, observational cohort study of patients evaluated for suspected acute coronary syndrome. They concluded that poor R wave progression in precordial leads with dominant QS pattern in V3 is the most predictive feature of reduced LVEF in suspected ACS. This feature constitutes a simple visual marker to aid clinicians in identifying those with impaired cardiac function.
- Changes to the electrocardiogram during exercise in anorexia nervosa
by Mikyla L. Janzen, Christopher C. Cheung, Nathaniel M. Hawkins, Julia Raudzus, ... Andrew D. Krahn- Highlights: Electrocardiogram (ECG) changes, particularly in the QT interval, have been implicated in anorexia nervosa-associated sudden death but not well defined. The authors evaluated QT intervals in a prospective cohort undergoing a 6-minute modified exercise test protocol. QTc intervals were similar between groups at baseline and end recovery. However, AN patients demonstrated QTc prolongation while controls showed QTc shortening at maximum HR. The authors concluded that QTc interval fails to shorten in subjects with anorexia nervosa, which may explain their increased arrhythmic risk.
volume 60, May/June 2020
This edition's highlighted articles are:
- Wide complex tachycardia differentiation: An examination of traditional and contemporary approaches.
by T.D. McGill, A.H. Kashou, A.J. Deshmukh, S. LoCoco, ... C.V. DeSimone- Highlights: After decades of rigorous clinical research, a wide variety of electrocardiographic criteria and algorithms have been developed to provide an accurate means to distinguish these two entities as accurately as possible. In this review, the authors aim to (1) highlight the clinical importance of accurate wide complex tachycardia differentiation, (2) provide an overview of the conventional manually-applied differentiation algorithms, and (3) describe novel automated approaches to differentiate wide complex tachycardia.
- Highlights: After decades of rigorous clinical research, a wide variety of electrocardiographic criteria and algorithms have been developed to provide an accurate means to distinguish these two entities as accurately as possible. In this review, the authors aim to (1) highlight the clinical importance of accurate wide complex tachycardia differentiation, (2) provide an overview of the conventional manually-applied differentiation algorithms, and (3) describe novel automated approaches to differentiate wide complex tachycardia.
- Different ECG patterns of left main coronary artery occlusion signifying varying degrees of ischemic severity.
by Z.-Q. Zhan, K. Nikus, Y. Birnbaum- Highlights: The authors present a patient with dynamic ECG changes that corresponded to changes in his clinical symptoms and hemodynamic status. This case with left main coronary artery disease illustrated three distinct ECG patterns with different severity of clinical symptoms signifying varying severity of ischemia. In left main coronary artery disease, the ST deviations in the precordial leads can be relatively minor. Left axis deviation or left anterior fascicular block with broad QRS possibly reflects left ventricular depolarization delay secondary to extensive ischemia.
volume 59, March/April 2020:
This edition's highlighted articles are:
- Different dynamics of new-onset electrocardiographic changes after balloon- and self-expandable transcatheter aortic valve replacement: Implications for prolonged heart rhythm monitoring.
by M. Coeman, P. Kayaert, T. Philipsen, S. Calle, ... J. De Pooter- Highlights: The authors aimed to compare the time course and dynamics of new onset ECG changes according to valve design in balloon- (BEV) and self-expandable (SEV) TAVR. Standard 12‑lead ECG was performed before the procedure, at 1, 24, 48 and 120 h and 1 month. In BEV patients, no significant PR prolongation occurred, whereas in SEV patients the PR interval prolonged significantly with 33.7 ± 22.0 ms (p < 0.001, compared to pre-TAVR) but only after 48 h after TAVR. The authors suggest that self-expandable valves cause more impairment in atrioventricular conduction with a delayed time course compared to balloon-expandable valves.
- Highlights: The authors aimed to compare the time course and dynamics of new onset ECG changes according to valve design in balloon- (BEV) and self-expandable (SEV) TAVR. Standard 12‑lead ECG was performed before the procedure, at 1, 24, 48 and 120 h and 1 month. In BEV patients, no significant PR prolongation occurred, whereas in SEV patients the PR interval prolonged significantly with 33.7 ± 22.0 ms (p < 0.001, compared to pre-TAVR) but only after 48 h after TAVR. The authors suggest that self-expandable valves cause more impairment in atrioventricular conduction with a delayed time course compared to balloon-expandable valves.
- Electrocardiogram to predict reperfusion success in late presenters with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention
by D.G. Topal, L. Nepper-Christensen, J. Lønborg, K. Aleksov Ahtarovski, ... T. Engstrøm- Highlights: The authors investigated the association between three ECG-scores and myocardial salvage and infarct size in late presenters treated with primary percutaneous coronary intervention (primary PCI). Cardiac magnetic resonance was performed at day 1 and at follow-up at day 93. The pre-PCI ECG was analyzed for the presence of pathological QW as well as Anderson-Wilkins acuteness score, the classic Sclarovsky-Birnbaum Ischemia Grading System and a modified SB-IG-score including any T-wave morphologies. They found that none of the three investigated ECG-scores were sufficient to guide clinical decision-making in patients with STEMI and ongoing symptoms presenting beyond 12 h of symptom onset.
volume 58, January/February 2020
This edition's highlighted articles are:
- Optimal measuring point for ST deviation in chest pain patients with possible acute coronary syndrome
by T. Lindow, J.Wiiala, J. Lundager Forberg, A.T. Lassen, M. Brabrand, P.G. Platonov, and U.Ekelund.
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Highlights: The authors evaluated the diagnostic accuracy for ACS at different ST-amplitude measuring points in ED chest pain patients. They found that the highest positive and negative predictive values for ACS were obtained near the J point but that this optimal point varied with ST deviation, age group, and sex. They concluded that the diagnostic accuracy of the ECG criteria for ACS is very low in ED chest pain patients.
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- QRS duration is associated with all-cause mortality in type 2 diabetes: The diabetes heart study.
by M.J. Singleton, C. German, K.J. Hari, G. Saylor, D.M. Herrington, E.Z. Soliman, B.I. Freedman, D.W. Bowden, P. D. Bhave, and J.Yeboah.
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Highlights: The authors of this Diabetes Heart Study found that 7.5% of study participants had QRS duration >120 ms and these patients had a substantially increased risk of death. They concluded that consideration of QRS duration may improve risk stratification in diabetic patients.
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volume 57, November/December 2019
This edition's highlighted articles are:
- Assessment of QT interval in ventricular paced rhythm: Derivation of a novel formulas
by Jacky K.K. Tang, Matthew T. Bennett, Simon W. Rabkin.
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Highlights: The authors set out to determine the optimal formula to estimate QT interval adjusting for QRS prolongation during right ventricular (RV) pacing. They have proposed a new, simple formula for QT estimation in RV pacing. JT interval in paced complexes is highly HR dependent and is not accurate for QT assessment. The new spline approach for HR correction for the QT, once incorporated into some previously proposed formulae, blunts HR dependency and improves prediction of QT before pacing.
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- Advanced interatrial block: An electrocardiographic marker for stroke recurrence.
by Camila S. García-Talavera, Álvaro Aceña, Alberto Andrés López, María Araceli García Torres, ... José Manuel Rubio.
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Highlights: The authors' objective in this study was to establish whether the presence of Ineratrial Block (IAB) could predict stroke recurrence in patients with a previous episode. They followed 149 patients and found that the presence of advanced IAB and diabetes were significantly associated with stroke recurrence. They conclude that the presence of advanced IAB predicts the recurrence of stroke in patients with a previous episode. As the natural next step, the authors suggest that further studies should be performed to investigate possible interventions.
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volume 56, September/October 2019
This edition's highlighted articles are:
- Distinctive ECG patterns in healthy black adults
by Brooks Walsh, Peter W. Macfarlane, Jordan M. Prutkin, Stephen W. Smith.
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Highlights: The authors set out to review those ECG patterns found more often in healthy black adults of African ancestry than in those of other backgrounds (e.g. white European ancestry). Their review, which focussed on non-athletes, highlights that a robust association of “black race” with certain ECG patterns can be found across a wide variety of black populations, from African American military veterans to Bantu villagers.
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- Electrocardiogram interpretation in NCAA athletes: Comparison of the 'Seattle' and 'International' criteria.
by Nicola Hyde, Jordan M. Prutkin, Jonathan A. Drezner.
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Highlights: The authors note that accurate electrocardiogram (ECG) interpretation in competitive athletes requires the distinction of physiological adaptations from findings suggestive of a pathological condition. The purpose of this study was to compare the performance of the Seattle Criteria to the International Criteria in a large dataset of NCAA athletes screened with an ECG.
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July/August 2019:
This edition's highlighted articles are:
- The effect of exercise on the ECG criteria for early repolarization pattern
by Hirmand Nouraei, and Simon W. Rabkin.
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Highlights: The authors set out to determine the effect of exercise and heart rate on the early repolarization (ER) pattern; focusing on the new criteria for identification of ER. After testing of 21 subjects, the concluded that each of the newly defined characteristics of the ER are modified and eventually disappear with exercise. The return of ER was dynamic with QRS notching of varying extent being evident first. The changes correlated with variations in heart rate, during both exercise and recovery, suggesting, in part, a role in the underlying mechanism of ER.
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- Electrocardiographic findings of acute total occlusion associated with a sub-occlusion involving the left anterior descending and the right coronary artery.
by Zhong-Qun Zhan, Yang-Hua Li, Yang Li, Jian-Ping Li, and Kjell C. Nikus.
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Highlights: The authors note that ECG characteristics of simultaneous acute occlusion/sub-occlusion of two coronary arteries involving the left anterior descending (LAD) and right (RCA) coronary artery have been rarely described in the literature. They present two patient cases, where one of the arteries was totally occluded and the other one had a sub-occlusion with severely limited flow to demonstrate the ECG characteristics of this severe presentation of acute coronary syndrome. They show that the two ECG patterns suggested simultaneous occlusions of the RCA and LAD.
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May/June 2019
This edition's highlighted articles are:
- Correction of the QRS duration for heart rate
by Jay W. Mason, David G. Strauss, Martino Vaglio, and Fabio Badilini.
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Highlights: The authors recently observed that the QRS duration shortens during spontaneous increases in heart rate. So they analyzed ECG and pharmacokinetic data of 21 subjects who received quinidine in a recent study. These subjects experienced the expected post-quinidine increase in heart rate, allowing the authors to determine if quinidine's well-known QRS prolongation might be attenuated due to the concomitant rate increase.
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- Prognostic significance of electrocardiographic right ventricular hypertrophy in the general population.
by Jamie Kowal, Muhammad Imtiaz Ahmad, Yabing Li, and Elsayed Z. Soliman.
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Highlights: The authors note that echocardiographically detected right ventricular hypertrophy (RVH) is associated with cardiovascular disease and mortality. However, the prognostic significance of electrocardiographic criteria as predictors of poor outcomes in the general population is unclear. They report a wide variation in the prevalence of ECG-RVH when different criteria are applied in the general population. However, the presence of ECG-RVH by most criteria regardless of prevalence was associated with poor prognosis suggesting that appropriate choice of criteria may enhance the utilization of these ECG markers in risk stratification.
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March/April 2019
This edition's highlighted articles are:
- Common source of miscalculation and misclassification of P-wave negativity and P-wave terminal force in lead V1.
by Maria Uggen Rasmussen, Andreas Fabricius-Bjerre, Preman Kumarathurai, Bjørn Strøier Larsen, and Ahmad Sajadieh.
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Highlights: The authors describe that misplacement, especially high placement, of precordial electrodes is common and that high placement results in a more than three-fold increase of P-wave terminal force. They also explain that deep terminal negativity is also increased by high placement of the V1 electrode. and theh high placement of the V1 electrode could be a common source of miscalculation.
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- Electrical remodelling post cardiac resynchronization therapy in patients with ischemic and non-ischemic heart failure
by Chukwudiebube N. Ajaero, Anand Ganesan, John D. Horowitz, Andrew D. McGavigan.
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Highlights: The authos describe the results that CRT reduced iQRSD in patients with non-ischemic cardiomyopathy and also decreased intramyocardial conduction times from left to right ventricles. The summarize that Improvement in electrical remodelling is correlated with functional improvement.
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January/February 2019
This edition's highlighted articles are:
- A deep neural network learning algorithm outperforms a conventional algorithm for emergency department electrocardiogram interpretation.
by Stephen W. Smith, Brooks Walsh, Ken Grauer, Kyuhyun Wang, JeremyRapin, Jai Li, William Fennell, and Pierre Taboulet.
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Highlights: The authors compared the first version of Cardiologs'® deep neural network (DNN) 12-lead ECG algorithm to a conventional algorithm and found that for non-controversial ECGs, the DNN had higher sensitivity for abnormalities, in addition to higher specificity and accuracy.
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- Poor reliability of P-wave terminal force V1 in ischemic stroke.
by Jithin K. Sajeev, Anoop N. Koshy, Helen Dewey, Jonathan M. Kalman, ManiniBhatia, Louise Roberts, Jennifer Cooke, Tanya Fronst, Rachel Denver, and Andrew W. Teh.
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Highlights: Several ECG markers are postulated to represent underlying atrial remodelling and have been associated with ischemic stroke. P-wave terminal force in lead V1 (PTFV1) is one such marker. The auhors examined the factors that contribute to the reliability of PTFV1 and its association with ischemic stroke. The utility of PTFV1 as a clinical marker for ischemic stroke is limited by the reduction in reliability associated with inter-observer and inter P-wave measurements.
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November/December 2018
This edition's highlighted articles are:
- The S-wave angle identifies arrhythmogenic right ventricular cardiomyopathy in patients with electrocardiographically concealed disease phenotype.
by DanielCortez, Anneli Svensson, JonasCarlson, SharonGraw, Nandita Sharma, Francesca Brun, Anita Spezzacatene, Luisa Mestroni, and Pyotr Platonov.
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Highlights: The S-wave angle identifies arrhythmogenic right ventricular cardiomyopathy in the absence of conventional or signal-averaged depolarization or repolarization abnormalities. The right precordial S-wave angle is a novel characteristic of depolarization that can be measured by protractor or automatically. Increased S-wave angle may identify patients with definite 2010 Taskforce criteria ARVC diagnosis in absence of conventional ECG criteria.
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- Association between typical electrocardiographic abnormalities and NT-proBNP elevation in a large cohort of patients with Chagas disease from endemic area.
by Bruno Oliveira de Figueiredo Brito, Marcelo Martins Pinto-Filho, Clareci Silva Cardoso, Claudia Di Lorenzo Oliveira, Ariela MotaFerreirac, Lea Campos de Oliveir, PauloGomes, Maria do Carmo Pereira Nunes, Ester Cerdeira Sabino and Antonio Luiz Pinho Ribeiro.
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Highlights: This summary describes electrocardiograms of a large cohort of patients with Chagas disease and reports that a) Typical ECG alterations of Chagas disease have greater odds of NT-proBNP elevation and b) Men had more major ECG abnormalities than women. The authors conclude that the ECG is a simple and accurate method to predict Chagas disease severity.
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September/October 2018
This edition's highlighted articles are:
- New Insights on Verapamil-Sensitive Idiopathic Left Fascicular Tachycardia.
by Yoav Michowitz and Bernard Belhassen
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Highlights: Ths review articles aims to summarize up to date aspects of Verapamil-sensitive left fascicular monomorphic ventricular tachycardia (LF-VT), which was first described ~4 decades ago. The article focuses on facets of the condition such as ECG recognition, new considerations of the reentrant circuit, ablation targets in inducible and non-inducible patients, and the approach to LF-VT with multiform morphology.
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- The ability of the electrocardiogram in left bundle branch block to detect myocardial scar determined by cardiovascular magnetic resonance.
by Björn Wieslander, Xiaojuan Xia, Robert Jablonowski, Jimmy Axelsson, Igor Klem, Robin Nijveldt, Charles Maynard, Erik B. Schelbert, Peder Sörensson, Andreas Sigfridsson, Uzma Chaudhry, Pyotr G. Platonov, Rasmus Borgquist, Henrik Engblom, Jean-Philippe Couderc, David G. Strauss, Brett D. Atwater, and Martin Ugander.
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Highlights: This large scale study underscores the persistent challenge of detecting myocardial scar in LBBB patients from the ECG. The international team of experts developed a multivariable logistic model for ECG scar detection in LBBB by comparing 44 selected semi-automatically measured ECG variables to CMR in 325 LBBB patients. Performance of the logistic model in this training set was moderate, with 54% sensitivity and 84% specificity; performance of the 2009 Selvester QRS score was also poor. Despite extensive comparison of ECG versus CMR, they were unable to identify ECG variables that correlated well with scar extent or location.
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July/August 2018
This edition's highlighted articles are:
- New ECG markers for predicting long-term mortality and morbidity in patients receiving cardiac resynchronization therapy.
by Kisiel, Fijorek, Moskal, Kukla, Sondej, Czarnecka, and Jastrzębski
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Highlights: The team investigated the prognostic value of four recently proposed ECG markers in patients with cardiac resynchronization therapy (CRT): 1. pathological preimplantation QRS axis, 2. increase in QRS amplitude in V3 during biventricular pacing, 3. negative QRS in V1/V2 during left ventricular (LV)-only pacing, and 4. longer QRS duration during LV-only pacing on 552 subjects. Long LV-paced QRS and pathological axis predicted unfavorable prognosis in Kaplan-Meier analysis. In multivariable Cox model (functional class, LV ejection fraction, LV end-diastolic dimension, permanent atrial fibrillation, age, gender, heart failure etiology, creatinine level, diabetes mellitus), LV-paced QRS duration remained a significant determinant of both endpoints. The other studied ECG markers lacked independent prognostic value.
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- Outcome of all-comers with STEMI based on the grade of ischemia in the presenting ECG.
by Koivula, Eskola, Viikilä, Lilleberg, Huhtala, Birnbaum, and Nikus.
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Highlights: The aim of the study was to establish the prognostic significance of grade 2 ischemia (G2I), G3I and the STEMI patients excluded from ischemia grading (No grade of ischemia, NG) in a real-life patient population. We assessed in-hospital, 30-day and 1-year mortality as well as other endpoints. The NG patients had more comorbidities and longer treatment delays than the two other groups. Short-term and 1-year mortality were highest in patients with NG and lowest in patients with G2I. Maximum troponin level was highest in G3I, followed by NG and G2I. In logistic regression multivariable analysis, NG was independently associated with 1-year mortality.
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May/June 2018
This edition's highlighted articles are:
- New formula for defining “normal” and “prolonged” QT in patients with bundle branch block.
by Yankelson, Hochstadt, Sadeh, Pick, Finkelstein, Rosso, and Sami Viskin.
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Highlights: The object of the study was to predict the QT interval in the presence of normal QRS for patients with left bundle branch block (LBBB). We measured the QT interval in patients with new onset LBBB who had a recent electrocardiogram with narrow QRS for comparison. 48 patients who developed in-hospital LBBB were studied. Patients who had similar heart rate before and after LBBB were included. We used linear regression, the Bogossian method, and our new fixed QRS replacement method to evaluate the most reliable correction method.
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- Normal values of the ventricular gradient and QRS-T angle, derived from the pediatric electrocardiogram.
by Kamphuis, Blom, van Zwet, Man, ten Harkel, Maan, and Swenne.
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Highlights: Normal values of the mathematically-synthesized vectorcardiogram (VCG) are lacking for children. Therefore, the objective of this study was to assess normal values of the pediatric synthesized VCG (spatial QRS-T angle [SA] and ventricular gradient [VG]).
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March/April 2018
This edition's highlighted articles are:
- Noninvasive clues for diagnosing ventricular tachycardia mechanism.
by Andres Enriquez, MD, Michael Riley, MD, and Francis Marchlinski, MD.
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Highlights: The electrophysiologic mechanism of ventricular tachycardia (VT) are enhanced automaticity, triggered activity and reentry. Understanding the VT mechanism is relevant for the prognosis, pharmacological therapy and ablation strategy. We review clues from the history, 12-lead ECG, monitoring and response to pharmacologic agents, to predict the VT mechanism.
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- Smartphone ECG for evaluation of ST-segment elevation myocardial infarction (STEMI): Design of the ST LEUIS International Multicenter Study
by Alejandro Barbagelata, MD, Charles F. Bethea, MD, Harry W. Severance, MD, Robert J. Mentz, MD, David Albert, MD, Gregory W. Barsness, MD, Viet T. Le, PA-C, Jeffrey L. Anderson, MD, T. Jared Bunch, MD, Frank Yanowitz, MD, Benjamin Chisum, BS, Brianna S. Ronnow, MS, Joseph B. Muhlestein, MD.
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Highlights: In STEMI patients, a 12-lead ECG is vital for rapid diagnosis and immediate access to treatment. New technology allows for 12-lead ECG readings through a smartphone app and attachment. ST LEUIS was designed to determine if the smartphone ECG is comparable to a standard 12-lead ECG.
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January/February 2018
This edition's highlighted articles are:
- Interatrial block, frailty, and prognosis in elderly patients with myocardial infarction.
by Eva Bernal, MD, Antoni Bayés-Genís, MD, PhD, Albert Ariza-Solé, MD, PhD, Francesc Formiga, MD, PhD, Maria T. Vidán, MD, PhD, Luis Alberto Escobar-Robledo, MS, Jaime Aboal, MD, Lídia Alcoberro, MD, Carme Guerrero, MD, Iván Ariza-Segovia, MD, Ana Hernández de Benito, MD, Pau Vilardell, MD, José Carlos Sánchez-Salado, MD, Victoria Lorente, MD, Antoni Bayés de Luna, MD, PhD, and Manuel Martinez-Sellés, MD, PhD
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Highlights: Almost one of each three elderly patients with myocardial infarction in sinus rythm do not have a normal P wave on ECG. Advanced interatrial block was associated with a trend toward more fraity, but not with the rest of geriatric syndromes. Elderly patients with MI and advanced IAB had a slightly higher mortality and new onset atrial fibrillation at one year.
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- Electrocardiographic recognition of right ventricular hypertrophy
by Kjell Nikus, MD, PhD, Andrés Ricardo Pérez-Riera, MD, PhDlink, Kaari Konttila, MS, and Raimundo Barbosa-Barros, MD.
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Highlights: The ECG is a relatively insensitive tool for the detection of right ventricular hypertrophy, but some criteria have high specificity. ECG criteria are not sensitive/specific enough for screening for mild right ventricular hypertrophy in adults without clinical cardiovascular disease. The greatest accuracy of the ECG is in congenital heart disease
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November/December 2017
This edition's highlighted article is
- Pathological S-wave in lead I in left bundle branch block is associated with MRI scar and reduced left ventricular function
by Brett D. Atwater, Jimmy Axelsson, Rasmus Borgquist, Uzma Chaudhry, Jean-Philippe Couderc, Henrik Engblom, Robert Jablonowski, Igor Klem, Zak Loring, Charles Maynard, Robin Nijveldt, Pyotr G. Platonov, Erik B. Schelbert, Andreas Sigfridsson, Peder Sörensson, David G. Strauss, Martin Ugander, Galen S. Wagner, Björn Wieslander, and Xiaojuan Xia
The ICE article for this edition is:
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JT interval: What does this interval mean?
by Wojciech Zareba, Scott McNitt, Slava Polonsky, Jean-Philippe Couderc
September/October 2017
This edition's highlighted article (available freely as open access!) is:
- Gender equity imbalance in electrocardiology: A call to action
by E Clarke Whalen, G Xu, I Cygankiewicz, L Bacharova, W Zareba, JS Steinberg, LG Tereshchenko, A Baranchuk.
Ljuba Bacharova (Left) and Erica Clarke Whalen (RIght) BSc.,(Honors), MSc., MBBS
The ICE article for this edition is:
- The ICE article for this edition is:
Pathological S-wave in lead I in left bundle branch block is associated with MRI scar and reduced left ventricular function
by Marek Jastrzębski, Piotr Kukla, Danuta Czarnecka
Published online: April 25, 2017
July, 2017
- IRIS-2017-Ukraine: the International Research Interdisciplinary School 2017, Zhovkva, Ukraine, May 8 -12, 2017
- Welcome to ISE from Andrian Baranchuk, ISE President
QRS duration is associated with all-cause mortality in type 2 diabetes: The diabetes heart study
CRT programed to allow biventricular fusion pacing significantly improved electrical synchrony and LVEF in patients with RBBB. Larger studies are required to confirm these findings.