Electrocardiographic Features Research Articles

Electrocardiographic characteristics and catheter ablation of premature ventricular complex- mediated ventricular fibrillation

Abstract Background Premature ventricular contractions (PVCs) can trigger ventricular fibrillation (VF) in patients with/or without structural heart disease. There are limited data on coexisting electrocardiographic (ECG) features and catheter ablation outcomes in these patients which could suggest the concomitant presence of an abnormal electrical and structural substrate. Purpose We investigated ECG and electroanatomic characteristics and clinical outcomes in patents who underwent catheter ablation of PVCs triggering VF. Methods We analyzed data from a consecutive series of patients who underwent catheter ablation between 08/2019 and 04/2023 for PVCs triggering VF. On the 12-lead ECG, we assessed the following abnormalities: (a) Early repolarization (ER) pattern in either inferior or lateral leads (Figure 1), or (b) QRS Notching of either the native sinus beat or PVC (Figure 2). Post-ablation follow up outcomes were collected using a combination of ICD interrogation, remote transmission and clinical follow up. Results The cohort included 15 patients: age 52.1±16.8 years, 46.7% females, and 26.7% presenting with VF storm. On average, there were 3.8 HV shocks/per patient from an ICD prior to the index ablation procedure (range: 0-19 shocks). On the 12-lead ECG, the mean coupling interval of the PVC leading to VF was 204±82 ms, and an overall narrow PVC morphology with a mean QRS duration of 107±17 ms. We observed early repolarization (ER) in 6 (40%) of the cohort. In most patients (n=11; 73.3%), at least one of the 2 ECG abnormalities were present. An endocardial-only approach was adequate in all patients, and during catheter ablation, Purkinje potentials were targeted in 10 (66%) of the patients. Based on activation and pace-mapping, the PVCs were localized to the following sites: (a) left ventricular (LV) septum in 11 (73.3%), (b) papillary muscles in 2 (13.3%), and (c) other sites such as the Moderator band and right ventricular outflow tract in the remaining 2 (13.3%) patients. The ablation locations on the LV septum extended from basal to mid-septum. After an average of 1.7 ablation procedures targeting PVC-triggering VF, 12 (80%) patients remained free of sustained ventricular arrhythmias and ICD shocks, over a mean follow up of 479±395 days. Conclusion In most patients with PVCs-triggering VF, there was an evidence of an ECG abnormality either in the form of an ER pattern or notching of either the Sinus QRS or the PVC complex on pre-ablation ECG. During ablation, Purkinje potentials and PVCs were mapped to and ablated in the region of the LV interventricular septum and papillary muscles. Over long-term follow up, catheter ablation seemed durable and effective in reducing VF episodes and ICD shocks.Presence of Early Repolarization patternPresence of a notching pattern in the Si

Electrocardiographic features in the early differential diagnosis of cardiac amyloidosis from cardiac sarcoidosis

Abstract Introduction Amyloidosis and sarcoidosis are both systemic infiltrative diseases which can cause cardiac involvement. Differentiating early-stage cardiac amyloidosis (CA) from cardiac sarcoidosis (CS) is still challenging, although hypertrophy for CA and septal thinning for CS are characteristic echocardiographic findings in each late-stage. The diagnosis is a time-sensitive issue, given the therapies for CA and CS likely to be effective at early disease stages. Purpose We aimed to evaluate the utility of electrocardiography (ECG) for distinguishing CA from CS before or early in the course of cardiomyopathy. Methods This study enrolled 36 consecutive patients (20 male, 75±13 years) diagnosed with transthyretin-CA in 25 (CA group) and isolated CS in 11 patients (CS group) according to accepted criteria at our institute from July 2014 to July 2023. We retrospectively reviewed electrocardiographic characteristics and clinical outcomes of early-stage CA and CS. Results The CS group were younger than the CA group at the time of diagnosis (59±9 vs 83±7 years, P<0.01) and had a shorter period between the date of their first ECG recording at our institute and the date of diagnosis (18±3 vs 62±67 months, P=0.012). Furthermore, the CA group showed specific P-waves with longer duration (142±19 vs 126±8 ms, P=0.003) and more notches and/or fragmentation (91% vs 33%, P=0.003) in the limb leads on the initial ECG than the CS group, although prolonged PR-interval is common in both CA and CS (191±44 vs. 208±43 ms, P=0.359). Unexpectedly, the CA group had a shorter QRS duration (103±25 vs 123±31 ms, P=0.047) and a higher R-wave in V5 (2.0±0.9 vs 1.3±1.1 mV, P=0.039) than the CS group. In addition, the low voltage in all limb leads, pseudoinfarct pattern and bundle branch block morphology characteristic of CA patients did not differ between diagnosis and initial examination. There were also no differences in atrial and ventricular arrhythmias. During the follow-up period, 5 patients (20%) in the CA group, but no patients in the CS group died. Conclusion CA and CS shares several electrocardiographic features. Prolonged P-wave with notches and fragmentation, suggesting atrial conduction disturbance, may be associated with amyloid deposition in CA. This finding might be useful in the early differential diagnosis for CA from CS.

Termination without global capture: electrocardiographic and anatomical characteristics using 3D-electroanatomical mapping system in reentrant ventricular tachycardia

Abstract Background Termination without global capture (TWGC) is the phenomenon which a pacing stimulus applied during ventricular tachycardia (VT) terminates the tachycardia without generating a QRS complex, and is considered as an indicator for the critical component of the circuit. The details of the electrocardiographic and anatomical characteristics of the site using a 3D-electroanatomical mapping system (3D-EAM) remain unknown. Purpose This study aimed to retrospectively analyze the cases that showed TWGC during VT mapping and ablation, and to investigate the electrocardiographic characteristics and relationship with the substrate identified by 3D-EAM. Methods Of 632 cases of VT associated with structural heart disease from July, 2019 to July, 2023 at a university hospital and a university medical center, cases with TWGC were analyzed. Results TWGC was observed in 10 patients (median age 61 years, 9 males, 5 ischemic cardiomyopathy, median LVEF 31%) at least once (12 times) in 11 locations. Local capture was observed in 6. The QRS morphology generated by continued pacing after TWGC matched the clinical VT in only 5 VTs (42%). Five showed decremental conduction of stimulus to QRS interval following the TWGC. In 11 locations, 4 corresponded to scar area (<0.1 mV) in the voltage map, 6 to border zone (0.1-1.5 mV), and 1 had no information on 3D-EAM. Of 12 times of TWGC, 3 were at the entrance, 1 at the central isthmus, and 1 at the exit. Acute elimination of clinical VT was successful in 7 of 10. Conclusions More than half of the sites with TWGC were located at the border zone in 3D-EAM. TWGC also occurred in the central or exit area, and local capture was observed frequently.Termination without global capture

Chronic inflammatory cardiomyopathy and its overlap with arrhythmogenic cardiomyopathy: long-term follow-up of a prospective single-centre cohort study

Abstract Background Chronic Inflammatory Cardiomyopathy (infl-CMP) may overlap with Arrhythmogenic Cardiomyopathy (ACM), a group of conditions with similar ventricular arrhythmic phenotypes and key imaging, electrocardiographic, histopathological, and genetic features. Purpose This single-centre cohort study aimed to assess the role of pathogenic genetic variants of ACM in long-term follow-up of patients with infl-CMP and ventricular arrhythmic phenotype. Methods In this prospective, single-centre study, 24 consecutive patients with suspected infl-CMP and ventricular arrhythmic phenotype were enrolled at our tertiary referral hospital between 2017 and 2022. Baseline demographic and clinical characteristics of the patients were collected. All patients underwent extensive workup, including electrocardiography, echocardiography, cardiac magnetic resonance, and genetic counselling and testing. Endomyocardial biopsy was performed if a definite diagnosis had not been reached after non-invasive diagnostic workup. Patients were classified according to phenotype as ACM (either definite or borderline), as indicated by the 2010 Padua Criteria, and genetically classified as genotype-positive or genotype-negative according to the presence of pathogenic variants for ACM. Long-term follow-up was performed to assess cardiovascular morbidity and mortality. The primary outcome was the occurrence of in-hospital admission for sustained ventricular tachyarrhythmias. Results At admission, 5 (21%) patients presented with syncope, 19 (79%) with high ventricular burden (>25% premature ventricular contractions) or with sustained ventricular tachyarrhythmias. After complete diagnostic work-up, 17 patients (71%) received a diagnosis of either definite or borderline ACM, while the remaining 7 patients (29%) received a diagnosis of infl-CMP. In 18 patients (75.0%), an endomyocardial biopsy was required as part of the diagnostic workup. In our population, the frequency of pathogenic ACM variants was 41% (8 variants in ACM patients and 2 variants in infl-CMP); in particular, pathogenic genetic variants coexisted in 2 patients (1 in the ACM group: PKP2 and KCNE1 mutations; 1 in the infl-CMP group: DSG2 and TMEM43 mutations). At a mean follow-up of 4.37 (SD ±1.77) years, the primary outcome occurred in 8 patients (33%), all identified as borderline or definite ACM (X²=4.94, p=0.026). Notably, sustained ventricular tachyarrhythmias occurred in 25% of genotype-negative and 50% of genotype-positive patients (X²=1.50, p=0.220). Conclusions Criteria-driven diagnosis of ACM was significantly associated with the occurrence of sustained ventricular tachyarrhythmias at long-term follow up. The presence of pathogenic genetic variants of ACM did not clearly stratify the ventricular arrhythmic risk as a single factor in our cohort of patients with ventricular arrhythmic phenotype.

Atrioventricular Nodal Reentrant Tachycardia in Kartagener’s Syndrome

Single case report of a middle-aged patient with Kartagener’s syndrome who experienced recurrent paroxysmal supraventricular tachycardia. Despite optimized beta-blocker therapy, only cardioversion in emergency departments provided symptomatic relief. The unique electrocardiographic features of this condition and their significance in transaortic electrophysiological studies for diagnosis and treatment are highlighted.

Left bundle fascicular versus left bundle trunk pacing: a comparison of their electrical synchrony parameters

Abstract Background Variation in human left bundle branch (LBB) anatomy has a significant effect on the sequence of left ventricular depolarization. However, little is known regarding the electrophysiological characteristics of pacing different LBB fascicles. Objective We aimed to analyse the different electrocardiographic characteristics of LBB pacing (LBBP) attending to the site of pacing at the LBB system. Methods In consecutive patients with confirmed LBBP, we distinguished left bundle trunk capture (LBTP) from any LB fascicular pacing (LBFP) based on the presence of LB potentials and paced QRS morphologies in the frontal axis. We compared them regarding procedure, LBBP criteria and electrical synchrony parameters. Results 309 patients with LBBAP attempt were analysed, with 290 successful cases. Among them, 223 were considered LBBP. 25 cases without a proper ECG tracing in the frontal leads were excluded from the final analysis. 173 patients with LBFP were compared to 25 patients with LBTP. There were not significant differences in the baseline characteristics, but the native QRS width was higher in the LBFP group (119.2±31.4 ms vs 103.2±20.5 ms; p=0.014). Regarding the procedural duration, there was not any significant difference. QRS transition criteria (80.0% vs 61.8%; p=0.077), selective LBBP (40.0 vs 21.5%; p=0.101), paced QRS width (110.3±16.8 ms vs 115.4±14.9 ms; p=0.117), V6-RWPT (79.2±10.7 ms vs 75.3±9.7 ms; p=0.068) and interpeak interval (42.5±19.1 ms vs 45.7±12.9 ms; p=0.282) were not significantly different between LBTP and LBFP. All short-term complications occurred in LBFP, mainly driven by septal perforations (n=23), without any difference in the pacing parameters. Among the LBFP subgroups, left septal (LSFP) and posterior (LPFP) fascicles were significantly more prevalent than left anterior (LAFP) in LBFP (46.8%, 41.0% and 12.2% respectively). Regarding the baseline characteristics, the procedural performance and the electrical synchrony parameters, there were not significant differences among the LBFP subgroups. Only aVL-RWPT was longer when the posterior fascicle was paced, and shorter in LAFP (84.7±13.3 ms vs 64.9±15.1 ms; p<0.001). The consecution of LSFP was more frequent with lumenless leads (97.5% vs 83.1% vs 81.0%, p=0.006). Attending to the LBBP criteria, transition criteria were more frequent in LSFP (71.6% vs 53.2%; p=0.039), along with selective capture (29.6% vs 16.3%%; p=0.042), and transition during pacing manoeuvres (82.8% vs 69.2% vs 40.0%; p=0.013). Conclusions LBFP is much more prevalent than LBTP in unselected consecutive patients with LBBP. LBFP seems more feasible, and as good as LBTP in terms of electrical synchrony and pacing safety, without significant differences among the LBFP subgroups. The recognition of the different paced QRS morphologies in the frontal axis, along with the analysis of the Purkinje potentials, arise as important tools to fully understand the whole map of LBBAP.Left bundle branch area sites of pacingProcedural and LBBP characteristics

PERMANENT JUNCTIONAL RECIPROCATING TACHYCARDIA: IT IS IMPORTANT TO KNOW HOW TO RECOGNIZE IT

Abstract Permanent junctional reciprocating tachycardia, also known as Coumel‘s tachycardia, is a rare form of supraventricular tachycardia that is usually incessant, characterised by retrograde conduction via an accessory pathway usually located in the posteroseptal region with slow and decremental conduction. Tachycardia is virtually incessant, at a rate ranging from 120 to 250 beats/minute. The electrocardiogram inscribes inverted P waves in leads II, III, AVF, as well as left lateral leads, along with a P–R interval shorter than the R–P interval during the tachycardia. The characteristic, but not diagnostic, electrocardiographic feature is a long R–P interval consistent with slow retrograde conduction. Spontaneous resolution of tachycardia is not un common. Electrocardiographically, it manifests as a narrow QRS tachycardia with long RP‘, with negative retrograde “p” waves in lower leads (D2, D3 and avF). The initiation and termination of the arrhythmia is not determined by a premature beat, but by critical changes in the RR cycle, that is, for values of the heart rate at which the activating front finds the retrograde decremental pathway outside refractoriness. Due to its incessant characteristic in some cases, patients may present tachycardiomyopathy, with myocardial dilation and ventricular dysfunction. We report the case of a 5–year–old girl who came in for onset of heart palpitation for several hours. On electrocardiogram finding of supraventricular tachycardia, narrow QRS, HR 170/min, negative p waves in DII–DIII–AVF. The electrocardiographic finding was compatible with a picture of permanent junctional reciprocating tachycardia. Following the administration of 50mg of phleicanide, there is a progressive reduction in heart rate until the clinical picture stabilizes. antiarrhythmic therapy was subsequently set with subsequent re–evaluation and discharge to the patient‘s home.

EXPLORING THE 12 LEAD ECG CHARACTERISTIC OF PAEDIATRIC AND YOUNG ADULT CARRIERS OF DESMOPLAKIN GENE VARIANTS

Abstract Background and Aim The DSP gene (locus. 6p24.3) encodes desmoplakin, a quintessential desmosomal protein for cellular adhesion, particularly within cardiac tissues. DSP gene variants can cause dilated cardiomyopathy, non–dilated left ventricular cardiomyopathy (NDLVC) and arrhythmogenic righ ventricular cardiomyopathy (ARVC), cardiac conditions known to trigger malignant ventricular arrhythmias and cause sudden cardiac death in young individuals. Nevertheless, the electrocardiographic (ECG) patterns in children carrying DSP variants are underexplored. Methods A retrospective analysis was conducted involving paediatric DSP gene variant carriers (</=18 years), followed at Great Ormond Street Hospital from 2006 to 2023. Their 12–lead ECGs were characterised and compared with those of an age and gender–matched healthy control group (χ2, p–value<0.05). Results 25 DSP carriers (64% females; 12.6±4 years) were identified [including 4 (16%) with an overt cardiomyopathy phenotype] and compared to 25 healthy matched controls (12.7±4.3years). Compared to the control group, DSP carriers exhibited a higher prevalence of low QRS voltages (72% vs 44%, p= 0.041), QRS notching (72% vs 26%, p= 0,014) and flattened T waves (72% vs 52%, p= 0,026). All 4 patients with an overt cardiomyopathy phenotype had widespread low QRS voltages and QRS fractionation, as well as flattened/inverted T waves, particularly in the inferior and lateral leads. Conclusion Predominant ECG features observed in paediatric patients with DSP gene variants included low QRS voltages, QRS notching, and flat or inverted T waves. Our findings suggest that ECG features may precede the development of an overt cardiomyopathy phenotype in children with DSP variants, but further studies with larger cohorts are needed to confirm this and to determine their prognostic significance.

Prevalence of abnormal electrocardiographic findings and associated factors among patients with epilepsy at Jimma Medical Center, Ethiopia; Hospital-based cross-sectional study.

A person with epilepsy experiences recurrent seizures as a result of a persistent underlying disorder. About 50 million people globally are impacted by it, with 4 million of those being in Sub-Saharan Africa. One of the most frequent comorbidities that raise the mortality and morbidity rates of epileptic patients is abnormal Electrocardiographic (ECG) findings. Thus, the purpose of this study is to evaluate the prevalence of abnormal ECG findings in epileptic patients that might lead to increased risk of sudden cardiac death. A hospital based cross-sectional study was at Jimma Medical Center of Ethiopia on epileptic patients who were on follow-up at neurologic clinics during the data collection period. The malignant ECG characteristics and was identified using the ECG abnormality tool. To facilitate analysis, the gathered data was imported into Epidata version 3.1 and exported to the SPSS version 26. The factors of abnormal ECG and sudden death risk were examined using bivariate logistic regression. The study comprised 190 epileptic patients, with a mean age of 32 years. There were more men than women, making up 60.2%. A 43.2% (n = 80) frequency of ECG abnormalities was identified. According to the study, early repolarization abnormalities were the most common ECG abnormalities and increased with male sex and the length of time a person had seizures (AOR) of 4.751 and 95% CI (.273,.933), p = 0.029, compared to their female counterparts. The frequency of malignant ECG alterations in epileptic patients on follow-up at Jimma Medical Center in Ethiopia is described in the study. According to the study, there were significant ECG alterations in epileptic individuals. Male gender and longer duration of epilepsy raise the risk of abnormal ECG findings that could result in sudden cardiac death.

Prevalence and electrocardiographic and electrophysiological characteristics of idiopathic ventricular arrhythmias originating from the septal left ventricular summit

AbstractIntroductionThe left ventricular summit (LVS) is the highest point on the epicardial surface of the left ventricle. A part of the LVS that is located between the left coronary arteries (lateral‐LVS) is one of the major sites of idiopathic ventricular arrhythmia (VA) origins. Some idiopathic epicardial VAs can be ablated at endocardial sites adjacent to the epicardial area septal to the lateral‐LVS (septal‐LVS). This study examined the prevalence and electrocardiographic and electrophysiological characteristics of septal‐LVS VAs.MethodsWe studied consecutive patients with idiopathic VAs originating from the LVS (67 patients) and aortic root (93 patients).ResultsBased on the ablation results, among 67 LVS VAs, 54 were classified as lateral and 13 as septal‐LVS VAs. As compared with the lateral‐LVS VAs, the septal‐LVS VAs were characterized by a greater prevalence of left bundle branch block with left inferior‐axis QRS pattern, later precordial transition, lower R‐wave amplitude ratio in leads III to II, lower Q‐wave amplitude ratio in leads aVL to aVR, and later local ventricular activation time relative to the QRS onset during VAs (V‐QRS) in the great cardiac vein. The electrocardiographic and electrophysiological characteristics of the septal‐LVS VAs were similar to those of the aortic root VAs. However, the V‐QRS at the successful ablation site was significantly later during the septal‐LVS VAs than aortic root VAs (p < .0001). The precordial transition was significantly later during the septal‐LVS VAs than aortic root VAs (p < .05).ConclusionsSeptal‐LVS VAs are considered a distinct subgroup of idiopathic VAs originating from the left ventricular outflow tract.

Mapping and Ablation of Premature Ventricular Complexes: State of the Art.

Premature ventricular complexes (PVCs) are common arrhythmias in clinical practice. Although benign and asymptomatic in most cases, PVCs may result in disabling symptoms, left ventricular systolic dysfunction, or PVC-induced ventricular fibrillation. Catheter ablation has emerged as a first-line therapy in such cases, with high rates of efficacy and low risk of complications. Significant progress in mapping and ablation technology has been made in the past 2 decades, along with the development of a growing body of knowledge and accumulated experience regarding PVC sites of origin, anatomical relationships, electrocardiographic characterization, and mapping/ablation strategies. This paper provides an overview of the main indications for catheter ablation of PVCs, electrocardiographic features, PVC mapping techniques, and contemporary ablation approaches. The authors also review the most common sites of PVC origin and the main considerations and challenges with ablation in each location.

Evaluation of Alterations in Basic Cardiac Functions in Operators of Artisanal Refineries in Rivers State, Nigeria

The impact of numerous artisanal refineries on the populace in Niger Delta region has been a great source of mainly health, economic and environmental concerns. Thus, the present study comparatively assessed the alterations of basic cardiac functions that may be associated with the operation of artisanal refineries (OAR) in Rivers State of Nigeria. This cross-sectional survey used a multi-stage sampling technique (including purposive and snowball tools) to recruit 203 (including 120 OAR-exposed and 83 non-OAR exposed) consenting and apparently healthy adult male and female subjects. With the use of the electrocardiographic (ECG) machine, the basic ECG indices were recorded from the study subjects. Quantitative data obtained from the subjects were subjected to statistical analyses using the Statistical Package for Social Sciences (SPSS) version 21.0. The result indicated significantly (P<0.0) elevated heart rates in the OAR-exposed subjects when compared to their non-OAR-exposed counterparts. Amongst the various ECG features, the exposed subjects predominantly presented with left atrial enlargement (LAE) (male exposed=57% and female exposed =46.3%) as against none in the unexposed group. And there was no significant association of the incidences of Abnormal/clinical ECG Features between the actively exposed (OAR operators) and passively exposed (residents in same city who are non-OAR operators) subjects. In conclusion, the operation of artisanal refineries in our locale may potentially predispose its operators to significant elevation of heart rate and incidences of abnormal ECG features.

Predictors of pacemaker requirement in patients receiving implantable loop recorders for unexplained syncope: A systematic review and meta-analysis

BackgroundImplantable loop recorders (ILRs) are increasingly used to evaluate patients with unexplained syncope. Identification of all predictors of bradycardic syncope and consequent permanent pacemaker (PPM) insertion is of substantial clinical interest as patients in the highest risk category may benefit from upfront pacemaker insertion. ObjectiveWe performed a systematic review and meta-analysis to identify risk predictors for PPM insertion in ILR recipients with unexplained syncope. MethodsAn electronic database search (MEDLINE, Embase, Scopus, Cochrane) was performed in June 2023. Studies evaluating ILR recipients with unexplained syncope and recording risk factors for eventual PPM insertion were included. A random effects model was used to calculate the pooled odds ratio (OR) for clinical and electrocardiographic characteristics with respect to future PPM requirement. ResultsEight studies evaluating 1007 ILR recipients were included; 268 patients (26.6%) underwent PPM insertion during study follow-up. PPM recipients were older (mean age, 70.2 ± 15.4 years vs 61.6 ± 19.7 years; P < .001). PR prolongation on baseline electrocardiography was a significant predictor of PPM requirement (pooled OR, 2.91; 95% confidence interval, 1.63–5.20). The presence of distal conduction system disease, encompassing any bundle branch or fascicular block, yielded a pooled OR of 2.88 for PPM insertion (95% confidence interval, 1.53–5.41). Injurious syncope and lack of syncopal prodrome were not significant predictors of PPM insertion. Sinus node dysfunction accounted for 62% of PPM insertions, whereas atrioventricular block accounted for 26%. ConclusionApproximately one-quarter of ILR recipients for unexplained syncope require eventual PPM insertion. Advancing age, PR prolongation, and distal conduction disease are the strongest predictors for PPM requirement.

Dyssynchronous heart failure models in canines: New insights into electrocardiographic, echocardiographic and histological features.

We investigated the similarities and differences between two experimental approaches using tachy-pacing technology to induce desynchronized heart failure in canines. A total of eight dogs were included in the experiment, four were tachy-paced in right ventricle apex (RVAP) and 4 were paced in right atrium after the ablation of left bundle branch to achieve left bundle branch block (RAP+LBBB). Three weeks of follow-up were conducted to observe the changes in cardiac function and myocardial staining was performed at the end of the experiment. Both experimental approaches successfully established heart failure with reduced ejection fraction models, with similar trends in declining cardiac function. The RAP+LBBB group exhibited a prolonged overall ventricular activation time, delayed left ventricular activation, and lesser impact on the right ventricle. The RVAP approach led to a reduction in overall right ventricular compliance and right ventricular enlargement. The RAP+LBBB group exhibited significant reductions in left heart compliance (LVGLS, %: RAP+LBBB -12.60 ± 0.12 to -5.93 ± 1.25; RVAP -13.28 ± 0.62 to -8.05 ± 0.63, p = 0.023; LASct, %: RAP+LBBB -15.75 ± 6.85 to -1.50 ± 1.00; RVAP -15.75 ± 2.87 to -10.05 ± 6.16, p = 0.035). Histological examination revealed more pronounced fibrosis in the left ventricular wall and left atrium in the RAP+LBBB group while the RVAP group showed more prominent fibrosis in the right ventricular myocardium. Both approaches establish HFrEF models with comparable trends. The RVAP group shows impaired right ventricular function, while the RAP+LBBB group exhibits more severe decreased compliance and fibrosis in left ventricle.

The relationship between morphological electrocardiographic characteristics and survival in critical COVID-19 patients

Background: Myocardial damage is a sign of poor prognosis in coronavirus disease 2019 (COVID-19). Electrocardiography (ECG) would be useful to evaluate the effects of ECG findings on survival in severe COVID-19. We studied the relationship of pathological ECG findings in patients of COVID-19 admitted in ICU with other adverse physiological parameters as well as the mortality.&#x0D; Methodology: The study population comprised critical COVID-19 patients in the intensive care unit (ICU). Patients with findings other than normal sinus rhythm, atrial extra beat, and ventricular extra beat were defined as patients with pathological ECG findings. Two groups were formed: patients with pathological ECG findings (n = 109) and patients without pathological ECG findings (n = 84). Data were compared and analysed between the groups. The relationship among the risk factors, and ECG findings with mortality was investigated.&#x0D; Results: The presence of hypertension (69% vs. 40%, OR 5.49, CI 1.71-17.66, P = 0.004), peripheral oxygen saturation (SpO2) (88 vs. 95, OR 0.8, CI 0.7-0.9, P &lt; 0.001) were found to be related to mortality in multivariable analyses. Patients with pathological ECG finding were older [74 (27-98) vs. 61 (22-89); P &lt; 0.001], and more likely to have hypertension (68% vs. 44%, P = 0.001). Pathological ECG findings (66% vs. 51%, P = 0.02), atrial fibrillation (AF) (37% vs. 20%, P = 0.01), right branch bundle block (RBBB) (10% vs. 3%, P = 0.048) were associated with higher mortality in univariable analyses.&#x0D; Conclusion: Although abnormal findings on ECG, especially AF and RBBB, are associated with a poor prognosis, they are not primary effective in increasing the mortality of critical COVID-19 patients.&#x0D; Abbreviations: AF- Atrial Fibrillation; CRP- C-reactive protein; ICU- intensive care unit; RBBB- Right Bundle-Branch Block; RT-PCR- reverse-transcription polymerase chain reaction; VTE- venous thromboembolism&#x0D; Key words: Atrial Fibrillation; Biomarkers; COVID-19; ECG; Mortality; Right Bundle-Branch Block&#x0D; Citation: Sayan M, Altinisik HB. The relationship between morphological electrocardiographic characteristics and survival in critical COVID-19 patients. Anaesth. pain intensive care 2024;28(1):139−150.&#x0D; DOI: 10.35975/apic.v28i1.2385&#x0D; Received: November 21, 2023; Reviewed: November 30, 2023; Accepted: December 21, 2023

Electrocardiographic features that militate against early hospital discharge after transcatheter aortic valve replacement

Electrocardiographic features that militate against early hospital discharge after transcatheter aortic valve replacement

Effects of COVID 19 on Electrocardiographic Parameters

The coronavirus disease (COVID-19) started in 2019 and became a pandemic by infecting many people all over the world. It is known that COVID-19 affects the heart as well as the respiratory system, and the changes it causes on the electrical activity of the heart are among the common research topics of recent studies. The electrical activity of the heart is measured by Electrocardiography (ECG). While some ECG devices give the ECG signal directly as numeric vector format, others draw the signal on paper or give results as an image. ECG images drawn on paper are usually only visually examined by the doctor, and detailed analysis is mostly attempted with low-accuracy machine learning methods. In this study, a new approach that converts ECG images drawn on paper into signals is proposed. The proposed approach was used to convert the ECG images recorded from COVID-19 and healthy people in an open source ECG image database into signals, and the obtained ECG signals were analysed in detail with signal processing methods and compared statistically between COVID-19 and healthy group and with similar studies in the literature. Results showed that, ECG characteristics were significantly changed with the COVID-19.

The role and application of current pharmacological management in patients with advanced heart failure.

In the last decades, several classifications and definitions have been proposed for advanced heart failure (ADVHF) patients, including clinical, functional, hemodynamic, imaging, and electrocardiographic features. Despite different inclusion criteria, ADVHF is characterized by some common items, such as drug intolerance, low arterial pressure, multiple organ dysfunction, chronic kidney disease, and diuretic use dependency. Additional features include fatigue, hypotension, hyponatremia, and unintentional weight loss associated with a specific laboratory profile reflecting systemic multiorgan dysfunction. Notably, studies evaluating guideline-directed medical therapy recently endorsed by guidelines in stable HF, including the 4 drug classes all together (i.e., betablocker, mineral corticoid antagonist, renin angiotensin inhibitors/neprilysin inhibitors, and sodium glucose transporter inhibitors), remain scarcely analyzed in ADVHF and New York Heart Association (NYHA) Class IV. Additionally, due to the common conditions associated with advanced stages, the balance between drug tolerance and potential benefits of the contemporary use of all agents is questioned. Therefore, less hard endpoints, such as exercise tolerance, quality of life (QoL) and self-competency, are not clearly demonstrated. Specific analyses evaluating outcome and rehospitalization of each drug provided conflicting results and are often limited to subjects with stable conditions and less advanced NYHA class. Current European Society of Cardiology/American Heart Association (ESC/AHA) Guidelines do not indicate the type of treatment, dosage, and administration modalities, and they do not suggest specific indications for ADVHF patients. Due to these concerns, there is an impelling need to understand what drugs may be used as the first line, what management leads to the better outcome, and what is the best treatment algorithm in this setting. In this paper, we summarize the most common pitfalls and limitations for the use of the traditional agents, and we propose a personalized approach aiming at preserve drug tolerance and maintaining adverse event protection and satisfactory QoL.

Clinical characteristics and outcome of cardiac resynchronization therapy for heart failure in National Hospital of Sri Lanka from year 2005 to 2020 – a retrospective observational study

BackgroundCardiac resynchronization therapy (CRT) has been a well-established treatment modality for moderate to severe left ventricular systolic dysfunction with left ventricular desynchrony. This is the pioneering study that analyses the cohort who underwent CRT implantation at the National Hospital of Sri Lanka (NHSL) in Colombo from 2005 to 2020.ObjectivesThis study was carried out to describe socio-demographic factors, improvements in clinical outcome (symptoms, electrocardiographic, and echocardiographic features), and post-CRT complications in the study population, as well as to determine the efficacy of CRT in heart failure.MethodA retrospective observational study was conducted on all the living patients who had undergone CRT implantation from 2005 to 2020. The data was gathered from all the consented patients who visited the device programming clinic using a physician-administered questionnaire and clinical records. Data was analyzed using SPSS 25, and significant statistics were assessed with the McNemer test, the Student T test, and the Chi-Squared test.ResultsThe study included 50 patients with a mean age of 52.82+/− 11.66 years and female predominance (56%, n = 28). Idiopathic dilated cardiomyopathy (50%, n = 25) was the leading etiological factor, followed by ischemic cardiomyopathy (28%, n = 14). Clinical symptoms have improved significantly with CRT implantation (p < 0.001). A significant improvement was found in NYHA functional class (p < 0.001, 95% CI = 0.072 to 0.284), QRS width (p < 0.001, 95% CI = 0.229 to 0.534), ejection fraction (p < 0.001, 95% CI = − 16.437 to − 8.504), and LV EDD (p < 0.001, 95% CI = 2.89 to 9.24). Post-CRT complications included lead malfunction (6%, n = 3) and chronic (14%, n = 7), bleeding or hematoma (2%, n = 1), pocket erosion or infection (6%, n = 3), and infective endocarditis (2%, n = 1).ConclusionAccording to the study, CRT significantly improves both clinical and functional outcomes in patients with moderate to severe heart failure.

Identification of Electrocardiographic Patterns Related to Mortality with COVID-19

COVID-19 is an infectious disease that has greatly affected worldwide healthcare systems, due to the high number of cases and deaths. As COVID-19 patients may develop cardiac comorbidities that can be potentially fatal, electrocardiographic monitoring can be crucial. This work aims to identify electrocardiographic and vectorcardiographic patterns that may be related to mortality in COVID-19, with the application of the Advanced Repeated Structuring and Learning Procedure (AdvRS&amp;LP). The procedure was applied to data from the “automatic computation of cardiovascular arrhythmic risk from electrocardiographic data of COVID-19 patients” (COVIDSQUARED) project to obtain neural networks (NNs) that, through 254 electrocardiographic and vectorcardiographic features, could discriminate between COVID-19 survivors and deaths. The NNs were validated by a five-fold cross-validation procedure and assessed in terms of the area under the curve (AUC) of the receiver operating characteristic. The features’ contribution to the classification was evaluated through the Local-Interpretable Model-Agnostic Explanations (LIME) algorithm. The obtained NNs properly discriminated between COVID-19 survivors and deaths (AUC = 84.31 ± 2.58% on hold-out testing datasets); the classification was mainly affected by the electrocardiographic-interval-related features, thus suggesting that changes in the duration of cardiac electrical activity might be related to mortality in COVID-19 cases.