| 1. |
- Akil, Shahnaz, et al.
(author)
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Stress-induced ST elevation with or without concomitant ST depression is predictive of presence, location and amount of myocardial ischemia assessed by myocardial perfusion SPECT, whereas isolated stress-induced ST depression is not
- 2016
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In: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 49:3, s. 15-307
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Journal article (peer-reviewed)abstract
- BACKGROUND: Evaluation of stress-induced ST deviations constitutes a central part when interpreting the findings from an exercise test. The aim of this analysis was to assess the pathophysiologic correlate of stress-induced ST elevation and ST depression with regard to presence, amount and location of myocardial ischemia as assessed by myocardial perfusion SPECT (MPS) in patients with suspected coronary artery disease.METHODS AND RESULTS: 226 patients who had undergone bicycle stress test in conjunction with MPS were included. Of these, 198 were consecutive patients while 28 patients were included on the basis of having stress-induced ST elevation mentioned in their clinical report. The amount and location of ST changes were related to MPS findings. Summed stress scores (SSS) from MPS images were used to measure the amount of stress-induced ischemia. The positive predictive values for detecting stress-induced ischemia were 28% for the consecutive patients with ST depression and 75% for patients with ST elevation. The maximum and sum of stress-induced ST elevations correlated with SSS (r(2)=0.58, p<0.001 and r(2)=0.73, p<0.001), whereas the maximum and sum of significant ST depressions did not (r(2)=0.022, p=0.08 and r(2)=0.024, p=0.10). The location of ST elevation corresponded to the location of ischemia by MPS (kappa=1.0), whereas the location of ST depression did not (kappa=0.20).CONCLUSIONS: Stress-induced ST elevation, with or without concomitant ST depression, is predictive of the presence, amount and location of myocardial ischemia assessed by MPS, whereas stress-induced ST depression without concomitant ST elevation is not.
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| 2. |
- Allencherril, Joseph, et al.
(author)
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Appropriateness of anteroseptal myocardial infarction nomenclature evaluated by late gadolinium enhancement cardiovascular magnetic resonance imaging
- 2018
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In: Journal of Electrocardiology. - : Elsevier BV. - 0022-0736. ; 51:2, s. 218-223
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Journal article (peer-reviewed)abstract
- Background: In traditional literature, it appears that "anteroseptal" MIs with Q waves in V1-V3 involve basal anteroseptal segments although studies have questioned this belief. Methods: We studied patients with first acute anterior Q-wave (>. 30. ms) MI. All underwent late gadolinium enhancement (LGE) cardiac magnetic resonance imaging (MRI). Results: Those with Q waves in V1-V2 (n = 7) evidenced LGE >. 50% in 0%, 43%, 43%, 57%, and 29% of the basal anteroseptal, mid anteroseptal, apical anterior, apical septal segments, and apex, respectively. Patients with Q waves in V1-V3 (n = 14), evidenced involvement was 14%, 43%, 43%, 50%, and 7% of the same respective segments. In those with extensive anterior Q waves (n = 7), involvement was 0%, 71%, 57%, 86%, and 86%. Conclusions: Q-wave MI in V1-V2/V3 primarily involves mid- and apical anterior and anteroseptal segments rather than basal segments. Data do not support existence of isolated basal anteroseptal or septal infarction. "Anteroapical infarction" is a more appropriate term than "anteroseptal infarction.".
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| 3. |
- Allencherril, Joseph, et al.
(author)
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Correlation of anteroseptal ST elevation with myocardial infarction territories through cardiovascular magnetic resonance imaging
- 2018
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In: Journal of Electrocardiology. - : Elsevier BV. - 0022-0736. ; 51:4, s. 563-568
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Journal article (peer-reviewed)abstract
- Background: Anteroseptal ST elevation myocardial infarction (STEMI) is traditionally defined on the electrocardiogram (ECG) by ST elevation (STE) in leads V1-V3, with or without involvement of lead V4. It is commonly taught that such infarcts affect the basal anteroseptal myocardial segment. While there are suggestions in the literature that Q waves limited to V1-V4 represent predominantly apical infarction, none have evaluated anteroseptal ST elevation territories. We compared the distribution of the myocardium at risk (MaR) in STEMI patients presenting with STE limited to V1-V4 and those with more extensive STE (V1-V6). Methods: We identified patients in the MITOCARE study presenting with a first acute STEMI and new STE in at least two contiguous anterior leads from V1 to V6. Patients underwent cardiac magnetic resonance (CMR) imaging three to five days after acute infarction. Results: Thirty-two patients met inclusion criteria. In patients with STE in V1-V4 (n = 20), myocardium at risk (MaR) > 50% was seen in 0%, 85%, 75%, 100%, and 90% in the basal anteroseptal, mid anteroseptal, apical anterior, apical septal segments, and apex, respectively. The group with STE in V1-V6 (n = 12), MaR > 50% was seen in 8%, 83%, 83%, 92%, and 83% of the same segments. Conclusions: Patients with acute STEMI and STE in leads V1-V4, exhibit MaR in predominantly apical territories and rarely in the basal anteroseptum. We found no evidence to support existence of isolated basal anteroseptal or septal STEMI. “Anteroapical” infarction is a more precise description than “anteroseptal” infarction for acute STEMI patients exhibiting STE in V1-V4.
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| 4. |
- Almer, Jakob, et al.
(author)
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Ischemic QRS prolongation as a biomarker of severe myocardial ischemia.
- 2016
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In: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 49:2, s. 139-147
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Journal article (peer-reviewed)abstract
- Previous studies have shown that QRS prolongation is a sign of depressed collateral flow and increased rate of myocardial cell death during coronary occlusion. The aims of this study were to evaluate ischemic QRS prolongation as a biomarker of severe ischemia by establishing the relationship between prolongation and collateral flow experimentally in a dog model, and test if the same pattern of ischemic QRS prolongation occurs in man.
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| 5. |
- Almer, Jakob, et al.
(author)
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Prevalence of manual Strauss LBBB criteria in patients diagnosed with the automated Glasgow LBBB criteria.
- 2015
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In: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 48:4, s. 558-564
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Journal article (peer-reviewed)abstract
- About one-third of patients undergoing cardiac resynchronization therapy because of left bundle branch block (LBBB) and heart failure do not improve. Strauss et al. have developed strict criteria to more accurately define complete LBBB in this patient group. The aim of this study was to investigate the prevalence of the manual application of the Strauss criteria for LBBB (QRS≥140ms in men, ≥130ms in women, along with mid-QRS notching/slurring) in consecutive patients who have been diagnosed with LBBB by the automated Glasgow criteria (QRS≥120ms).
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| 6. |
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| 7. |
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| 8. |
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| 9. |
- Axelsson, Jimmy, et al.
(author)
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Ejection fraction in left bundle branch block is disproportionately reduced in relation to amount of myocardial scar
- 2018
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In: Journal of Electrocardiology. - : Elsevier BV. - 0022-0736 .- 1532-8430. ; 51:6, s. 1071-1076
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Journal article (peer-reviewed)abstract
- Introduction: The relationship between left ventricular (LV) ejection fraction (EF) and LV myocardial scar can identify potentially reversible causes of LV dysfunction. Left bundle branch block (LBBB) alters the electrical and mechanical activation of the LV. We hypothesized that the relationship between LVEF and scar extent is different in LBBB compared to controls. Methods: We compared the relationship between LVEF and scar burden between patients with LBBB and scar (n = 83), and patients with chronic ischemic heart disease and scar but no electrocardiographic conduction abnormality (controls, n = 90), who had undergone cardiovascular magnetic resonance (CMR) imaging at one of three centers. LVEF (%) was measured in CMR cine images. Scar burden was quantified by CMR late gadolinium enhancement (LGE) and expressed as % of LV mass (%LVM). Maximum possible LVEF (LVEFmax) was defined as the function describing the hypotenuse in the LVEF versus myocardial scar extent scatter plot. Dysfunction index was defined as LVEFmax derived from the control cohort minus the measured LVEF. Results: Compared to controls with scar, LBBB with scar had a lower LVEF (median [interquartile range] 27 [19–38] vs 36 [25–50] %, p < 0.001), smaller scar (4 [1–9] vs 11 [6–20] %LVM, p < 0.001), and greater dysfunction index (39 [30–52] vs 21 [12–35] % points, p < 0.001). Conclusions: Among LBBB patients referred for CMR, LVEF is disproportionately reduced in relation to the amount of scar. Dyssynchrony in LBBB may thus impair compensation for loss of contractile myocardium.
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| 10. |
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| 11. |
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| 12. |
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| 13. |
- Bergfeldt, Lennart, 1950, et al.
(author)
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Ventricular repolarization duration and dispersion adaptation after atropine induced rapid heart rate increase in healthy adults.
- 2017
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In: Journal of electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 50:4, s. 424-432
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Journal article (peer-reviewed)abstract
- Proper adaptation of ventricular repolarization (VR) to rapid heart rate (HR) increase is crucial for cardiac electro-mechanical function. The pattern and temporal aspects of this adaptation and its components (duration and dispersion) during normal conduction are, however, incompletely known in humans and were the topic of this study.The VR duration (QT & QTpeak) and dispersion (Tamplitude, Tarea & ventricular gradient; VG) responses were studied by continuous vectorcardiogram after a bolus injection of atropine 0.04mg/kg b.w. in 31 healthy young adults (16 men). The primary measure (T90 End) was the time to reach 90% change from baseline to end value 300s later. Mean (SD) of T90 End was 23 (9) s for a 41% RR decrease, 130 (35) s for a 16% QTend decrease and 110 (36) s for a 19% QTpeak decrease; the response was single-exponential for these measures. For 35-43% decreases of Tamplitude, Tarea & VG, mean (SD) of T90 End were 21 (10), 38 (20) and 40 (23) s and the response pattern was double-exponential with varying overshoot.VR duration and dispersion responses to a very rapid HR increase during normal conduction differed substantially. In contrast to the well-known single-exponential delay in VR duration adaptation the responses of VR dispersion measures were double-exponential and much more rapid. We describe a new and completely non-invasive phenotypic characterization of different components of VR adaptation.
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| 14. |
- Chaudhry, U., et al.
(author)
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Idiopathic ventricular fibrillation – Long term prognosis in relation to clinical findings and ECG patterns in a Swedish cohort
- 2019
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In: Journal of Electrocardiology. - Philadephia : Churchill Livingstone Inc. Medical Publishers. - 0022-0736 .- 1532-8430. ; 56, s. 46-51
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Journal article (peer-reviewed)abstract
- Background: Idiopathic ventricular fibrillation (IVF) is a rare cause of sudden cardiac arrest which may pose therapeutic and prognostic challenges. To date, the only effective treatment for survivors of cardiac arrest is the insertion of an implantable cardioverter-defibrillator (ICD). We sought to review the long-term outcome of a Swedish cohort with IVF.Methods and results: Fifty patients with IVF diagnosis between 1988 and 2016 (mean age at index 34.3, 56% male), were followed for a median 13.8 years in this retrospective multicenter observational study. No cardiac mortality was reported. 32% (n = 16) of patients had recurrence of ventricular fibrillation or sustained ventricular tachycardia, requiring ICD therapy, at a median time of 1.9 years (range 0.1–20.3) from the index event. Annual incidence rate of ventricular tachyarrhythmia was 3.1%. Abnormal ECG at baseline did not predict appropriate ICD therapy (p = 0.56). During the follow-up period, 14% (n = 7) patients received a cardiac diagnosis. Follow-up genetic testing was low (26%), however did confirm pathogenic mutations in three cases.Conclusion: Idiopathic VF is a rare diagnosis with a relatively good prognosis provided ICD therapy is initiated. Routine clinical follow-up is recommended due to potential late emerging cardiac pathology. ECG changes are common, but have no prognostic value in determining the risk of ventricular arrhythmias recurrence. Screening for genetic diseases has previously been low, and this calls for improvement, especially since cheaper and more comprehensive genetic panels are now readily available.
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| 15. |
- Corino, Valentina D A, et al.
(author)
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Noninvasive characterization of atrioventricular conduction in patients with atrial fibrillation.
- 2015
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In: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 48:6, s. 938-942
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Journal article (peer-reviewed)abstract
- The atrioventricular (AV) node plays a fundamental role in patients with atrial fibrillation (AF), acting as a filter to the numerous irregular atrial impulses which bombard the node. A phenomenological approach to better understand AV nodal electrophysiology is to analyze the ventricular response with respect to irregularity. In different cohorts of AF patients, such analysis has been performed with the aim to evaluate the association between ventricular response characteristics and long-term clinical outcome and to determine whether irregularity is affected by rate-control drugs. Another approach to studying AV nodal characteristics is to employ a mathematical model which accounts for the refractory periods of the two AV nodal pathways. With atrial fibrillatory rate and RR intervals as input, the model has been considered for analyzing data during (i) rest and head-up tilt test, (ii) tecadenoson and esmolol, and (iii) rate-control drugs. The present paper provides an overview of our recent work on the characterization and assessment of AV nodal conduction using these two approaches.
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| 16. |
- Cortez, Daniel, et al.
(author)
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ECG-derived spatial QRS-T angle is strongly associated with hypertrophic cardiomyopathy
- 2017
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In: Journal of Electrocardiology. - : Elsevier BV. - 0022-0736 .- 1532-8430. ; 50:2, s. 195-202
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Journal article (peer-reviewed)abstract
- Introduction: ECG-derived vectorcardiography (VCG) has diagnostic and prognostic value in various diseases. Hypertrophic cardiomyopathy (HCM), a genetic disease with unexplained left ventricular hypertrophy, is one of the most common causes of sudden cardiac death (SCD) in young persons. Genotype positive status is associated with increased risk of systolic dysfunction, heart failure, and (SCD). Herein, we aimed to determine the diagnostic utility of derived VCG parameters in a large cohort of genotyped HCM patients. Methods: Between 1997 and 2007, genetic testing was performed on 1053 unrelated patients with HCM. Of these, 967 had 12-lead ECGs suitable for computerized derivation of VCG parameters, including the spatial mean and peaks QRS-T angles, spatial ventricular gradient (SVG), spatial QRS, QT, and Tpeak-Tend (TpTe) intervals. ECGs were also evaluated using Seattle ECG criteria. Differences between HCM patients and healthy controls as well as between genotype positive versus genotype negative HCM patients were assessed. Results: Spatial peaks (129.3. ±. 26.4 vs.30.5. ±. 24.2 degrees) and spatial mean QRS-T angles (121.8. ±. 38.6 vs. 47.3. ±. 27.6 degrees) were significantly higher in patients with HCM than in controls (P. <. 0.001). The spatial peaks and mean QRS-T angles identified 94% and 84% of HCM patients, respectively, while Seattle criteria identified 70.7% of patients (P. <. 0.001). Genotype positive patients had higher spatial mean QRS-T angles, spatial TpTe (P. <. 0.001 respectively), spatial peaks QRS-T angles (P. =0.017) and lower SVG (P. <. 0.001) than genotype negative patients. Conclusions: ECG-derived spatial QRS-T angles can differentiate patients with HCM from controls and could provide a better tool than traditional Seattle criteria. Clinical usefulness of VCG to differentiate genotype-negative from genotype-positive patients has yet to be established.
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| 17. |
- Cortez, Daniel, et al.
(author)
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Non-invasive electrocardiographic predictors of atrial arrhythmias in patients with the Fontan palliation
- 2017
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In: Journal of Electrocardiology. - : Elsevier BV. - 0022-0736. ; 50:5, s. 576-583
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Journal article (peer-reviewed)abstract
- Background: Fontan palliation patients are at risk for atrial arrhythmias post-operatively. This study aimed to evaluate whether differences in depolarization vector magnitude or spatial P-R angle can reliably predict atrial arrhythmias in patients who had undergone Fontan palliation. Methods: A total of 115 patients who had Fontan palliation and post-Fontan catheterization were included. Atrial arrhythmias were identified in 14 patients. Measurements of ECG parameters including QRS vector magnitude, P-R duration, spatial QRS-T angle and spatial P-R angle were performed, and compared between those with and without atrial arrhythmias. Results: Only the QRSvm independently differentiated those with and without atrial arrhythmias with multivariate HR of 0.743 (95% CI 0.581 to 0.951). Conclusion: In Fontan patients, the QRSvm was the only significant independent predictor of atrial arrhythmias.
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| 18. |
- Cortez, Daniel, et al.
(author)
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The S-wave angle identifies arrhythmogenic right ventricular cardiomyopathy in patients with electrocardiographically concealed disease phenotype
- 2018
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In: Journal of Electrocardiology. - : Elsevier BV. - 0022-0736 .- 1532-8430. ; 51:6, s. 1003-1008
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Journal article (peer-reviewed)abstract
- Background: Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) carries risk of sudden death. We hypothesize that the S-wave angle differentiates ARVD/C with otherwise normal electrocardiograms from controls. Materials and methods: All patients met Task Force 2010 definite ARVD/C criteria. ARVD/C patients without Task Force depolarization/repolarization criteria (−ECG) were compared to controls. Electrocardiogram measures of QRS duration, corrected QT interval, and measured angle between the upslope and downslope of the S-wave in V2, were assessed. Results: Definite ARVD/C was present in 155 patients (42.7 ± 17.3 years, 68.4%male). −ECG ARVD/C patients (66 patients) were compared to 66 control patients (41.8 ± 17.6 years, 65.2%male). Only the S-wave angle differentiated −ECG ARVD/C patients from controls (<0.001) with AU the ROC curve of 0.77 (95%CI 0.53 to 0.71) and odds ratio of 28.3 (95%CI 6.4 to 125.5). Conclusion: ARVD/C may lead to development of subtle ECG abnormalities distinguishable using the S-wave angle prior to development of 2010 Taskforce ECG criteria.
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| 19. |
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| 20. |
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| 21. |
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| 22. |
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| 23. |
- Demidova, Marina M, et al.
(author)
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QRS broadening due to terminal distortion is associated with the size of myocardial injury in experimental myocardial infarction
- 2016
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In: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 49:3, s. 300-306
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Journal article (peer-reviewed)abstract
- INTRODUCTION: Not only repolarization, but also depolarization ECG indexes reflect the progression of ischemic injury. The aim was to assess the QRS duration and morphology dynamics during the prolonged coronary occlusion and their association with the myocardial area at risk (MaR) and final infarct size (IS).METHODS: In pigs, myocardial infarction was induced by inflation of an angioplasty balloon in the left descending artery (LAD), and ECG was continuously recorded. QRS duration was calculated on a beat-to-beat basis during the occlusion period. Single photon emission computed tomography (SPECT) was performed for the assessment of MaR, and IS was assessed by magnetic resonance imaging (MRI).RESULTS: All animals developed an anteroseptal infarction with MaR 40±9% and IS 23±7%. Two peaks of QRS widening were found in all animals: the early peak immediately after LAD occlusion and the late one 17.7±4.1min later. No association was found between MaR and IS and either QRS width or the degree of QRS widening at the early peak. QRS duration on the late peak correlated with both MaR (r=0.61; p=0.007) and IS (r=0.55; p=0.018).CONCLUSION: The QRS widening at the late peak, but not at the early peak, is associated with the size of myocardial injury, suggesting different underlying mechanisms.
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| 24. |
- Elmberg, Viktor, et al.
(author)
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A 12-lead ECG-method for quantifying ischemia-induced QRS prolongation to estimate the severity of the acute myocardial event.
- 2016
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In: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 49:3, s. 272-277
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Journal article (peer-reviewed)abstract
- Studies have shown terminal QRS distortion and resultant QRS prolongation during ischemia to be a sign of low cardiac protection and thus a faster rate of myocardial cell death. A recent study introduced a single lead method to quantify the severity of ischemia by estimating QRS prolongation. This paper introduces a 12-lead method that, in contrast to the previous method, does not require access to a prior ECG.
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| 25. |
- Engels, E. B., et al.
(author)
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The synthesized vectorcardiogram resembles the measured vectorcardiogram in patients with dyssynchronous heart failure
- 2015
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In: Journal of Electrocardiology. - : Elsevier BV. - 0022-0736 .- 1532-8430. ; 48:4, s. 586-592
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Journal article (peer-reviewed)abstract
- Background: The use of vectorcardiography (VCG) has regained interest, however, original Frank-VCG equipment is rare. This study compares the measured VCGs with those synthesized from the 12-lead electrocardiogram (ECG) in patients with heart failure and conduction abnormalities, who are candidate for cardiac resynchronization therapy (CRT). Methods: In 92 CRT candidates, Frank-VCG and 12-lead ECG were recorded before CRT implantation. The ECG was converted to a VCG using the Kors method (Kors-VCG) and the two methods were compared using correlation and Bland-Altman analyses. Results: Variables calculated from the Frank- and Kors-VCG showed correlation coefficients between 0.77 and 0.90. There was a significant but small underestimation by the Kors-VCG method, relative bias ranging from -1.9%+/- 4.6% (QRS-T angle) to -9.4%+/- 20.8% (T area). Conclusion: The present study shows that it is justified to use Kors-VCG calculations for VCG analysis, which enables retrospective VCG analysis of previously recorded ECGs in studies related to CRT. (C) 2015 Elsevier Inc. All rights reserved.
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| 26. |
- Fakhri, Yama, et al.
(author)
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Electrocardiographic scores of severity and acuteness of myocardial ischemia predict myocardial salvage in patients with anterior ST-segment elevation myocardial infarction
- 2018
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In: Journal of Electrocardiology. - : Elsevier BV. - 0022-0736. ; 51:2, s. 195-202
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Journal article (peer-reviewed)abstract
- Background: Terminal "QRS distortion" on the electrocardiogram (ECG) (based on Sclarovsky-Birnbaum's Grades of Ischemia Score) is a sign of severe ischemia, associated with adverse cardiovascular outcome in ST-segment elevation myocardial infarction (STEMI). In addition, ECG indices of the acuteness of ischemia (based on Anderson-Wilkins Acuteness Score) indicate myocardial salvage potential. We assessed whether severe ischemia with or without acute ischemia is predictive of infarct size (IS), myocardial salvage index (MSI) and left ventricular ejection fraction (LVEF) in anterior versus inferior infarct locations. Methods: In STEMI patients, the severity and acuteness scores were obtained from the admission ECG. Based on the ECG patients were assigned with severe or non-severe ischemia and acute or non-acute ischemia. Cardiac magnetic resonance (CMR) was performed 2-6. days after primary percutaneous coronary intervention (pPCI). LVEF was measured by echocardiography 30. days after pPCI. Results: ECG analysis of 85 patients with available CMR resulted in 20 (23%) cases with severe and non-acute ischemia, 43 (51%) with non-severe and non-acute ischemia, 17 (20%) with non-severe and acute ischemia, and 5 (6%) patients with severe and acute ischemia. In patients with anterior STEMI (n = 35), ECG measures of severity and acuteness of ischemia identified significant and stepwise differences in myocardial damage and function. Patients with severe and non-acute ischemia had the largest IS, smallest MSI and lowest LVEF. In contrast, no difference was observed in patients with inferior STEMI (n = 50). Conclusions: The applicability of ECG indices of severity and acuteness of myocardial ischemia to estimate myocardial damage and salvage potential in STEMI patients treated with pPCI, is confined to anterior myocardial infarction.
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| 27. |
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| 28. |
- Gizurarson, Sigfus, et al.
(author)
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Atrial fibrillation in patients admitted to coronary care units in western Sweden - focus on obesity and lipotoxicity.
- 2015
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In: Journal of electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 48:5, s. 853-60
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Journal article (peer-reviewed)abstract
- Atrial fibrillation (AF) is the most common form of arrhythmia in humans and is associated with substantial morbidity and mortality. Obesity and diabetes have been linked to myocardial lipotoxicity - a condition where the heart accumulates and produces toxic lipid species. We hypothesized that obesity and diabetes were involved in the pathophysiology of AF by means of promoting a lipotoxic phenotype in atrial muscle, and that AF predicts mortality in cardiac care patients.
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| 29. |
- Hakacova, Nina
(author)
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The ability of mitral papillary muscle positions to explain QRS complex characteristics in humans
- 2016
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In: Journal of Electrocardiology. - : Elsevier BV. - 0022-0736. ; 49:5, s. 680-685
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Research review (peer-reviewed)abstract
- Anatomical location of the conduction system may influence the characteristics of the depolarization and thus characteristics of the QRS complex. It is known that in the heart, there are electro-anatomical relationships, such as relationships among the molecular, genetic and anatomic components of the conduction system and papillary muscles. This review aims to discuss how knowledge of the electro-anatomical developmental relationships helps in understanding the known variability to be observed in the human electrocardiograms.
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| 30. |
- Hill, JA, et al.
(author)
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Medical misinformation: Vet the message!
- 2019
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In: Journal of electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 53, s. 112-113
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Journal article (other academic/artistic)
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| 31. |
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| 32. |
- I. FERNLUND, EVA, et al.
(author)
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MYBPC3 hypertrophic cardiomyopathy can be detected by using advanced ECG in children and young adults
- 2016
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In: Journal of Electrocardiology. - : Elsevier BV. - 0022-0736 .- 1532-8430. ; 49:3, s. 392-400
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Journal article (peer-reviewed)abstract
- Introduction The conventional ECG is commonly used to screen for hypertrophic cardiomyopathy (HCM), but up to 25% of adults and possibly larger percentages of children with HCM have no distinctive abnormalities on the conventional ECG, whereas 5 to 15% of healthy young athletes do. Recently, a 5-min resting advanced 12-lead ECG test ("A-ECG score") showed superiority to pooled criteria from the strictly conventional ECG in correctly identifying adult HCM. The purpose of this study was to evaluate whether in children and young adults, A-ECG scoring could detect echocardiographic HCM associated with the MYBPC3 genetic mutation with greater sensitivity than conventional ECG criteria and distinguish healthy young controls and athletes from persons with MYBPC3 HCM with greater specificity. Methods Five-minute 12-lead ECGs were obtained from 15 young patients (mean age 13.2 years, range 0-30 years) with MYBPC3 mutation and phenotypic HCM. The conventional and A-ECG results of these patients were compared to those of 198 healthy children and young adults (mean age 13.2, range 1 month-30 years) with unremarkable echocardiograms, and to those of 36 young endurance-trained athletes, 20 of whom had athletic (physiologic) left ventricular hypertrophy. Results Compared with commonly used, age-specific pooled criteria from the conventional ECG, a retrospectively generated A-ECG score incorporating results from just 2 derived vectorcardiographic parameters (spatial QRS-T angle and the change in the vectorcardiographic QRS azimuth angle from the second to the third eighth of the QRS interval) increased the sensitivity of ECG for identifying MYBPC3 HCM from 46% to 87% (p <0.05). Use of the same score also demonstrated superior specificity in a set of 198 healthy controls (94% vs. 87% for conventional ECG criteria; p <0.01) including in a subset of 36 healthy, young endurance-trained athletes (100% vs. 69% for conventional ECG criteria, p <0.001). Conclusions In children and young adults, a 2-parameter 12-lead A-ECG score is retrospectively significantly more sensitive and specific than pooled, age-specific conventional ECG criteria for detecting MYBPC3-HCM and in distinguishing such patients from healthy controls, including endurance-trained athletes.
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| 33. |
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| 34. |
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| 35. |
- Karlsson, Daniel, et al.
(author)
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Exercise testing for long-term follow-up in arrhythmogenic right ventricular cardiomyopathy
- 2017
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In: Journal of Electrocardiology. - : Churchill Livingstone. - 0022-0736 .- 1532-8430. ; 50:2, s. 176-183
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Journal article (peer-reviewed)abstract
- Objectives: We investigated arrhythmia, electrocardiography and physical work capacity (PWC) in the follow-up of ARVC. Design: Twenty-three patients (13 men; age 41 +/- 12 years) fulfilling diagnostic criteria were re-investigated after at least five years. Results: Ventricular arrhythmia during exercise testing (ET) was present in 14 patients (61%) and showed variation between examinations. In eleven (48%), complex ventricular ectopic activity was observed at peak exercise or immediately thereafter. Mutations known to be pathogenic in ARVC were present in 13 patients (57%) of which 11 developed complex ventricular arrhythmia at ET. PWC at baseline was 190 +/- 66 W (104 +/- 26%) decreasing to 151 +/- 61 W (91 +/- 23%, p = 0.008) after 10.7 years. Conclusion: The appearance of ventricular arrhythmia during exercise testing showed temporal variation but was.frequent in patients with relevant genetic mutation. Physical exercise capacity decreased over time in patients with ARVC in excess to the age-related deterioration and regardless of medication. (C) 2016 Elsevier Inc. All rights reserved.
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| 36. |
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| 37. |
- Lam, Anny, et al.
(author)
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The classical versus the Cabrera presentation system for resting electrocardiography: Impact on recognition and understanding of clinically important electrocardiographic changes.
- 2015
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In: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 48:4, s. 476-482
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Research review (peer-reviewed)abstract
- The classical system for presentation of the 12-lead electrocardiogram (ECG) reflects the electrical activity of the heart as viewed in the transverse plane by 6 leads with a single anatomically ordered sequence, V1-V6; but in the frontal plane by 6 leads with dual sequences, I, II, and III, and aVR, aVL, and aVF. However, there is also a single anatomically ordered sequence of leads, called the Cabrera display that presents the six frontal plane leads in their anatomically ordered sequence of: aVL, I, -aVR, II, aVF, and III. Although it has been recognized that the Cabrera system has clinical diagnostic advantages compared to the classical display, it is currently only used in Sweden. The primary explanation of why the Cabrera system has not been adopted internationally has been that analog ECG recorders had technical limitations. Currently, however, the classical system is most often seen as a historical remnant that prevails because of conservatism within the cardiology community.
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| 38. |
- Lindow, Thomas, et al.
(author)
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A patient with non-ST-segment elevation acute coronary syndrome : Is it possible to predict the culprit coronary artery?
- 2016
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In: Journal of Electrocardiology. - : Elsevier BV. - 0022-0736. ; 49:4, s. 614-619
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Journal article (peer-reviewed)abstract
- In acute coronary syndromes without ST-segment elevation (NSTE-ACS), identification of the culprit artery is, most often, not possible. In this case report, we elaborate on the likelihood of different culprit arteries in a patient with NSTE-ACS. While her symptoms were progressing, typical ECG findings of ischemia in the left coronary territories were diminishing. Instead, dynamic T-wave changes in the inferior leads were present and were most likely postischemic and "reischemic." Although the culprit artery could not be identified with certainty by means of these subtle changes, they correlated well with the findings on angiography and the ECG recorded afterward. This case report demonstrates the importance of analyzing ECG and its temporal changes in conjunction with evolving symptoms.
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| 39. |
- Lindow, Thomas, et al.
(author)
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The Olson method for detection of acute myocardial ischemia in patients with coronary occlusion
- 2017
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In: Journal of Electrocardiology. - : Elsevier BV. - 0022-0736. ; 50:1, s. 74-81
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Journal article (peer-reviewed)abstract
- An automated ECG-based method may provide diagnostic support in the management of patients with acute coronary syndrome. The Olson method has previously proved to accurately identify the culprit artery in patients with acute coronary occlusion. Methods The Olson method was applied to 360 patients without acute myocardial ischemia and 52 patients with acute coronary occlusion. Results This study establishes the normal variation of the Olson wall scores in patients without acute myocardial ischemia, which provides the basis for implementation of the Olson method for triage of patients with acute coronary syndrome. All patients with acute occlusion had Olson wall scores above the upper limit of normal. Conclusion The Olson method can be used for ischemia detection with very high sensitivity. Future studies are needed to explore specificity in patients with non-ischemic ST elevation.
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| 40. |
- Ljungström, Erik, et al.
(author)
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Combination of a leadless pacemaker and subcutaneous defibrillator with nine effective shock treatments during follow-up of 18 months
- 2019
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In: Journal of Electrocardiology. - : Elsevier BV. - 0022-0736. ; 56, s. 1-3
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Journal article (peer-reviewed)abstract
- We present a case of combination of a leadless pacemaker (Micra) and a subcutaneous implantable cardioverter-defibrillator (S-ICD). The patient had a total of nine adequate shock treatments of ventricular fibrillation during 18 months of follow-up after the implantation. The shock treatments did not lead to any alteration in the Micra. All three sensing vectors of the S-ICD worked well. After 18 months, the functioning of both Micra and S-ICD continues to be uneventful. This case demonstrates that S-ICD combined with Micra may be a safe and feasible approach to provide pacing and ICD treatment without intracardiac leads.
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| 41. |
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| 42. |
- Pahlm, Olle, et al.
(author)
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Scientific MALT and STAFF meetings - past, present, and future
- 2016
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In: Journal of Electrocardiology. - : Elsevier BV. - 0022-0736. ; 49:3, s. 259-262
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Research review (peer-reviewed)abstract
- The scientific STAFF and MALT meetings were created around the turn of the century for scientists engaged in enhancing the role of the 12-lead ECG for detection and quantification of involved myocardium in patients with acute coronary syndrome. These meetings were initially focused on computer processing of data from two single-center databases. The STAFF database was collected in the mid-nineties on patients with prolonged total coronary occlusion; high-resolution 12-lead ECGs were collected before, during, and after 5 minutes of occlusion. The MALT database was created in the early years of this century on consecutive patients with chest pain admitted to a large teaching hospital. Delayed enhancement magnetic resonance imaging and electrocardiograms were recorded in these acutely ill patients. The paper highlights the first 2 decades of the STAFF and MALT meetings and details the meeting format.
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| 43. |
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| 44. |
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| 45. |
- Petrėnas, A, et al.
(author)
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A modified Lewis ECG lead system for ambulatory monitoring of atrial arrhythmias.
- 2015
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In: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 48:2, s. 157-163
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Journal article (peer-reviewed)abstract
- When using a reduced ECG lead system with three leads or less, the analysis of atrial activity during arrhythmias can become problematic due to low signal amplitude and noise. Long ago, Sir Thomas Lewis proposed a lead system for atrial activity enhancement in which two electrodes are placed directly on the chest, however, these leads are sensitive to arm movement artifacts. In this study, a modified Lewis lead system is proposed that is better suited for ambulatory applications since the electrodes are placed in areas with less muscle.
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| 46. |
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| 47. |
- Reitan, C., et al.
(author)
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Semi-automated QRS score as a predictor of survival in CRT treated patients with strict left bundle branch block
- 2018
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In: Journal of Electrocardiology. - : Elsevier BV. - 0022-0736. ; 51:2, s. 282-287
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Journal article (peer-reviewed)abstract
- Background: Cardiac Resynchronization Therapy (CRT) is widely used for treating selected heart failure patients, but patients with myocardial scar respond worse to treatment. The Selvester QRS scoring system estimates myocardial scar burden using 12-lead ECG. This study's objective was to investigate the scores correlation to mortality in a CRT population. Methods and results: Data on consecutive CRT patients was collected. 401 patients with LBBB and available ECG data were included in the study. QuAReSS software was used to perform Selvester scoring. Mean Selvester score was 6.4, corresponding to 19% scar burden. The endpoint was death or heart transplant; outcome was analyzed using Cox proportional hazards models. A Selvester score >. 8 was significantly associated with higher risk of the combined endpoint (HR 1.59, p = .014, CI 1.09-2.3). Conclusion: Higher Selvester scores correlate to mortality in CRT patients with strict LBBB and might be of value in prognosticating survival.
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| 48. |
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| 49. |
- Sejersten, Maria, et al.
(author)
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Myocardium at risk assessed by electrocardiographic scores and cardiovascular magnetic resonance - a MITOCARE substudy
- 2017
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In: Journal of Electrocardiology. - : Elsevier BV. - 0022-0736. ; 50:6, s. 725-731
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Journal article (peer-reviewed)abstract
- Introduction: The myocardium at risk (MaR) represents the quantitative ischemic area destined to myocardial infarction (MI) if no reperfusion therapy is initiated. Different ECG scores for MaR have been developed, but there is no consensus as to which should be preferred. Objective: Comparisons of ECG scores and Cardiac Magnetic Resonance (CMR) for determining MaR. Methods: MaR was determined by 3 different ECG scores, and by CMR in ST-segment elevation MI (STEMI) patients from the MITOCARE cardioprotection trial. The Aldrich score (AL) is based on the number of leads with ST-elevation for anterior MI and the sum of ST-segment elevation for inferior MI on the admission ECG. The van Hellemond score (VH) considers both the ischemic and infarcted component of the MaR by adding the AL and the QRS score, which is an estimate of final infarct size. The Hasche score is based on the maximal possible infarct size determined from the QRS score on the baseline ECG. Results: Ninety-eight patients (85% male, mean age 61. years) met STEMI criteria on their admission ECG and underwent CMR within 3-5. days after STEMI. Mean MaR by CMR was 41.2. ±. 10.2 and 30.3. ±. 7.2 for anterior and inferior infarcts, respectively. For both anterior and inferior infarcts the Aldrich (18.2. ±. 5.1 and 18.6. ±. 6.0) and Hasche (25.3. ±. 9.8 and 26.4. ±. 8.8) scores significantly underestimated MaR compared to MaR measured by CMR. In contrast, MaR by the van Hellemond score (37.0. ±. 14.2 and 31.7. ±. 12.8) was comparable to CMR. Conclusion: We tested the performance of the electrocardiographic estimation of myocardium area at risk by Aldrich, Hasche and van Hellemond ECG scores in comparison to MaR measured by CMR in STEMI patients. MaR by the van Hellemond score and CMR were comparable, while Aldrich and Hasche underestimated MaR.
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| 50. |
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