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Showing 1 - 200 of 1584 Journals sorted alphabetically
Abacus     Hybrid Journal   (Followers: 12, SJR: 0.48, h-index: 22)
About Campus     Hybrid Journal   (Followers: 5)
Academic Emergency Medicine     Hybrid Journal   (Followers: 58, SJR: 1.385, h-index: 91)
Accounting & Finance     Hybrid Journal   (Followers: 45, SJR: 0.547, h-index: 30)
ACEP NOW     Free   (Followers: 1)
Acta Anaesthesiologica Scandinavica     Hybrid Journal   (Followers: 51, SJR: 1.02, h-index: 88)
Acta Archaeologica     Hybrid Journal   (Followers: 137, SJR: 0.101, h-index: 9)
Acta Geologica Sinica (English Edition)     Hybrid Journal   (Followers: 3, SJR: 0.552, h-index: 41)
Acta Neurologica Scandinavica     Hybrid Journal   (Followers: 5, SJR: 1.203, h-index: 74)
Acta Obstetricia et Gynecologica Scandinavica     Hybrid Journal   (Followers: 15, SJR: 1.197, h-index: 81)
Acta Ophthalmologica     Hybrid Journal   (Followers: 5, SJR: 0.112, h-index: 1)
Acta Paediatrica     Hybrid Journal   (Followers: 56, SJR: 0.794, h-index: 88)
Acta Physiologica     Hybrid Journal   (Followers: 6, SJR: 1.69, h-index: 88)
Acta Polymerica     Hybrid Journal   (Followers: 9)
Acta Psychiatrica Scandinavica     Hybrid Journal   (Followers: 35, SJR: 2.518, h-index: 113)
Acta Zoologica     Hybrid Journal   (Followers: 6, SJR: 0.459, h-index: 29)
Acute Medicine & Surgery     Hybrid Journal   (Followers: 2)
Addiction     Hybrid Journal   (Followers: 33, SJR: 2.086, h-index: 143)
Addiction Biology     Hybrid Journal   (Followers: 12, SJR: 2.091, h-index: 57)
Adultspan J.     Hybrid Journal   (SJR: 0.127, h-index: 4)
Advanced Energy Materials     Hybrid Journal   (Followers: 24, SJR: 6.411, h-index: 86)
Advanced Engineering Materials     Hybrid Journal   (Followers: 26, SJR: 0.81, h-index: 81)
Advanced Functional Materials     Hybrid Journal   (Followers: 50, SJR: 5.21, h-index: 203)
Advanced Healthcare Materials     Hybrid Journal   (Followers: 13, SJR: 0.232, h-index: 7)
Advanced Materials     Hybrid Journal   (Followers: 249, SJR: 9.021, h-index: 345)
Advanced Materials Interfaces     Hybrid Journal   (Followers: 6, SJR: 1.177, h-index: 10)
Advanced Optical Materials     Hybrid Journal   (Followers: 5, SJR: 2.488, h-index: 21)
Advanced Science     Open Access   (Followers: 5)
Advanced Synthesis & Catalysis     Hybrid Journal   (Followers: 17, SJR: 2.729, h-index: 121)
Advances in Polymer Technology     Hybrid Journal   (Followers: 13, SJR: 0.344, h-index: 31)
Africa Confidential     Hybrid Journal   (Followers: 19)
Africa Research Bulletin: Economic, Financial and Technical Series     Hybrid Journal   (Followers: 12)
Africa Research Bulletin: Political, Social and Cultural Series     Hybrid Journal   (Followers: 9)
African Development Review     Hybrid Journal   (Followers: 35, SJR: 0.275, h-index: 17)
African J. of Ecology     Hybrid Journal   (Followers: 14, SJR: 0.477, h-index: 39)
Aggressive Behavior     Hybrid Journal   (Followers: 15, SJR: 1.391, h-index: 66)
Aging Cell     Open Access   (Followers: 10, SJR: 4.374, h-index: 95)
Agribusiness : an Intl. J.     Hybrid Journal   (Followers: 6, SJR: 0.627, h-index: 14)
Agricultural and Forest Entomology     Hybrid Journal   (Followers: 14, SJR: 0.925, h-index: 43)
Agricultural Economics     Hybrid Journal   (Followers: 44, SJR: 1.099, h-index: 51)
AIChE J.     Hybrid Journal   (Followers: 29, SJR: 1.122, h-index: 120)
Alcoholism and Drug Abuse Weekly     Hybrid Journal   (Followers: 7)
Alcoholism Clinical and Experimental Research     Hybrid Journal   (Followers: 7, SJR: 1.416, h-index: 125)
Alimentary Pharmacology & Therapeutics     Hybrid Journal   (Followers: 35, SJR: 2.833, h-index: 138)
Alimentary Pharmacology & Therapeutics Symposium Series     Hybrid Journal   (Followers: 3)
Allergy     Hybrid Journal   (Followers: 49, SJR: 3.048, h-index: 129)
Alternatives to the High Cost of Litigation     Hybrid Journal   (Followers: 3)
American Anthropologist     Hybrid Journal   (Followers: 128, SJR: 0.951, h-index: 61)
American Business Law J.     Hybrid Journal   (Followers: 24, SJR: 0.205, h-index: 17)
American Ethnologist     Hybrid Journal   (Followers: 91, SJR: 2.325, h-index: 51)
American J. of Economics and Sociology     Hybrid Journal   (Followers: 27, SJR: 0.211, h-index: 26)
American J. of Hematology     Hybrid Journal   (Followers: 31, SJR: 1.761, h-index: 77)
American J. of Human Biology     Hybrid Journal   (Followers: 12, SJR: 1.018, h-index: 58)
American J. of Industrial Medicine     Hybrid Journal   (Followers: 16, SJR: 0.993, h-index: 85)
American J. of Medical Genetics Part A     Hybrid Journal   (Followers: 15, SJR: 1.115, h-index: 61)
American J. of Medical Genetics Part B: Neuropsychiatric Genetics     Hybrid Journal   (Followers: 3, SJR: 1.771, h-index: 107)
American J. of Medical Genetics Part C: Seminars in Medical Genetics     Partially Free   (Followers: 5, SJR: 2.315, h-index: 79)
American J. of Orthopsychiatry     Hybrid Journal   (Followers: 4, SJR: 0.756, h-index: 69)
American J. of Physical Anthropology     Hybrid Journal   (Followers: 36, SJR: 1.41, h-index: 88)
American J. of Political Science     Hybrid Journal   (Followers: 252, SJR: 5.101, h-index: 114)
American J. of Primatology     Hybrid Journal   (Followers: 15, SJR: 1.197, h-index: 63)
American J. of Reproductive Immunology     Hybrid Journal   (Followers: 3, SJR: 1.347, h-index: 75)
American J. of Transplantation     Hybrid Journal   (Followers: 16, SJR: 2.792, h-index: 140)
American J. on Addictions     Hybrid Journal   (Followers: 9, SJR: 0.843, h-index: 57)
Anaesthesia     Hybrid Journal   (Followers: 120, SJR: 1.404, h-index: 88)
Analyses of Social Issues and Public Policy     Hybrid Journal   (Followers: 11, SJR: 0.397, h-index: 18)
Analytic Philosophy     Hybrid Journal   (Followers: 16)
Anatomia, Histologia, Embryologia: J. of Veterinary Medicine Series C     Hybrid Journal   (Followers: 3, SJR: 0.295, h-index: 27)
Anatomical Sciences Education     Hybrid Journal   (Followers: 1, SJR: 0.633, h-index: 24)
Andrologia     Hybrid Journal   (Followers: 2, SJR: 0.528, h-index: 45)
Andrology     Hybrid Journal   (Followers: 2, SJR: 0.979, h-index: 14)
Angewandte Chemie     Hybrid Journal   (Followers: 159)
Angewandte Chemie Intl. Edition     Hybrid Journal   (Followers: 210, SJR: 6.229, h-index: 397)
Animal Conservation     Hybrid Journal   (Followers: 34, SJR: 1.576, h-index: 62)
Animal Genetics     Hybrid Journal   (Followers: 8, SJR: 0.957, h-index: 67)
Animal Science J.     Hybrid Journal   (Followers: 6, SJR: 0.569, h-index: 24)
Annalen der Physik     Hybrid Journal   (Followers: 5, SJR: 1.46, h-index: 40)
Annals of Anthropological Practice     Partially Free   (Followers: 2, SJR: 0.187, h-index: 5)
Annals of Applied Biology     Hybrid Journal   (Followers: 8, SJR: 0.816, h-index: 56)
Annals of Clinical and Translational Neurology     Open Access   (Followers: 1)
Annals of Human Genetics     Hybrid Journal   (Followers: 9, SJR: 1.191, h-index: 67)
Annals of Neurology     Hybrid Journal   (Followers: 44, SJR: 5.584, h-index: 241)
Annals of Noninvasive Electrocardiology     Hybrid Journal   (Followers: 2, SJR: 0.531, h-index: 38)
Annals of Public and Cooperative Economics     Hybrid Journal   (Followers: 9, SJR: 0.336, h-index: 23)
Annals of the New York Academy of Sciences     Hybrid Journal   (Followers: 5, SJR: 2.389, h-index: 189)
Annual Bulletin of Historical Literature     Hybrid Journal   (Followers: 12)
Annual Review of Information Science and Technology     Hybrid Journal   (Followers: 14)
Anthropology & Education Quarterly     Hybrid Journal   (Followers: 24, SJR: 0.72, h-index: 31)
Anthropology & Humanism     Hybrid Journal   (Followers: 16, SJR: 0.137, h-index: 3)
Anthropology News     Hybrid Journal   (Followers: 14)
Anthropology of Consciousness     Hybrid Journal   (Followers: 11, SJR: 0.172, h-index: 5)
Anthropology of Work Review     Hybrid Journal   (Followers: 11, SJR: 0.256, h-index: 5)
Anthropology Today     Hybrid Journal   (Followers: 93, SJR: 0.545, h-index: 15)
Antipode     Hybrid Journal   (Followers: 45, SJR: 2.212, h-index: 69)
Anz J. of Surgery     Hybrid Journal   (Followers: 6, SJR: 0.432, h-index: 59)
Anzeiger für Schädlingskunde     Hybrid Journal   (Followers: 1)
Apmis     Hybrid Journal   (Followers: 1, SJR: 0.855, h-index: 73)
Applied Cognitive Psychology     Hybrid Journal   (Followers: 67, SJR: 0.754, h-index: 69)
Applied Organometallic Chemistry     Hybrid Journal   (Followers: 7, SJR: 0.632, h-index: 58)
Applied Psychology     Hybrid Journal   (Followers: 136, SJR: 1.023, h-index: 64)
Applied Psychology: Health and Well-Being     Hybrid Journal   (Followers: 48, SJR: 0.868, h-index: 13)
Applied Stochastic Models in Business and Industry     Hybrid Journal   (Followers: 5, SJR: 0.613, h-index: 24)
Aquaculture Nutrition     Hybrid Journal   (Followers: 14, SJR: 1.025, h-index: 55)
Aquaculture Research     Hybrid Journal   (Followers: 31, SJR: 0.807, h-index: 60)
Aquatic Conservation Marine and Freshwater Ecosystems     Hybrid Journal   (Followers: 34, SJR: 1.047, h-index: 57)
Arabian Archaeology and Epigraphy     Hybrid Journal   (Followers: 11, SJR: 0.453, h-index: 11)
Archaeological Prospection     Hybrid Journal   (Followers: 12, SJR: 0.922, h-index: 21)
Archaeology in Oceania     Hybrid Journal   (Followers: 13, SJR: 0.745, h-index: 18)
Archaeometry     Hybrid Journal   (Followers: 27, SJR: 0.809, h-index: 48)
Archeological Papers of The American Anthropological Association     Hybrid Journal   (Followers: 14, SJR: 0.156, h-index: 2)
Architectural Design     Hybrid Journal   (Followers: 25, SJR: 0.261, h-index: 9)
Archiv der Pharmazie     Hybrid Journal   (Followers: 4, SJR: 0.628, h-index: 43)
Archives of Drug Information     Hybrid Journal   (Followers: 4)
Archives of Insect Biochemistry and Physiology     Hybrid Journal   (SJR: 0.768, h-index: 54)
Area     Hybrid Journal   (Followers: 12, SJR: 0.938, h-index: 57)
Art History     Hybrid Journal   (Followers: 215, SJR: 0.153, h-index: 13)
Arthritis & Rheumatology     Hybrid Journal   (Followers: 51, SJR: 1.984, h-index: 20)
Arthritis Care & Research     Hybrid Journal   (Followers: 28, SJR: 2.256, h-index: 114)
Artificial Organs     Hybrid Journal   (Followers: 1, SJR: 0.872, h-index: 60)
ASHE Higher Education Reports     Hybrid Journal   (Followers: 14)
Asia & the Pacific Policy Studies     Open Access   (Followers: 14)
Asia Pacific J. of Human Resources     Hybrid Journal   (Followers: 316, SJR: 0.494, h-index: 19)
Asia Pacific Viewpoint     Hybrid Journal   (SJR: 0.616, h-index: 26)
Asia-Pacific J. of Chemical Engineering     Hybrid Journal   (Followers: 7, SJR: 0.345, h-index: 20)
Asia-pacific J. of Clinical Oncology     Hybrid Journal   (Followers: 6, SJR: 0.554, h-index: 14)
Asia-Pacific J. of Financial Studies     Hybrid Journal   (SJR: 0.241, h-index: 7)
Asia-Pacific Psychiatry     Hybrid Journal   (Followers: 3, SJR: 0.377, h-index: 7)
Asian Economic J.     Hybrid Journal   (Followers: 8, SJR: 0.234, h-index: 21)
Asian Economic Policy Review     Hybrid Journal   (Followers: 4, SJR: 0.196, h-index: 12)
Asian J. of Control     Hybrid Journal   (SJR: 0.862, h-index: 34)
Asian J. of Endoscopic Surgery     Hybrid Journal   (SJR: 0.394, h-index: 7)
Asian J. of Organic Chemistry     Hybrid Journal   (Followers: 4, SJR: 1.443, h-index: 19)
Asian J. of Social Psychology     Hybrid Journal   (Followers: 5, SJR: 0.665, h-index: 37)
Asian Politics and Policy     Hybrid Journal   (Followers: 13, SJR: 0.207, h-index: 7)
Asian Social Work and Policy Review     Hybrid Journal   (Followers: 5, SJR: 0.318, h-index: 5)
Asian-pacific Economic Literature     Hybrid Journal   (Followers: 5, SJR: 0.168, h-index: 15)
Assessment Update     Hybrid Journal   (Followers: 4)
Astronomische Nachrichten     Hybrid Journal   (Followers: 2, SJR: 0.701, h-index: 40)
Atmospheric Science Letters     Open Access   (Followers: 29, SJR: 1.332, h-index: 27)
Austral Ecology     Hybrid Journal   (Followers: 12, SJR: 1.095, h-index: 66)
Austral Entomology     Hybrid Journal   (Followers: 10, SJR: 0.524, h-index: 28)
Australasian J. of Dermatology     Hybrid Journal   (Followers: 8, SJR: 0.714, h-index: 40)
Australasian J. On Ageing     Hybrid Journal   (Followers: 7, SJR: 0.39, h-index: 22)
Australian & New Zealand J. of Statistics     Hybrid Journal   (Followers: 13, SJR: 0.275, h-index: 28)
Australian Accounting Review     Hybrid Journal   (Followers: 4, SJR: 0.709, h-index: 14)
Australian and New Zealand J. of Family Therapy (ANZJFT)     Hybrid Journal   (Followers: 3, SJR: 0.382, h-index: 12)
Australian and New Zealand J. of Obstetrics and Gynaecology     Hybrid Journal   (Followers: 43, SJR: 0.814, h-index: 49)
Australian and New Zealand J. of Public Health     Hybrid Journal   (Followers: 11, SJR: 0.82, h-index: 62)
Australian Dental J.     Hybrid Journal   (Followers: 6, SJR: 0.482, h-index: 46)
Australian Economic History Review     Hybrid Journal   (Followers: 4, SJR: 0.171, h-index: 12)
Australian Economic Papers     Hybrid Journal   (Followers: 23, SJR: 0.23, h-index: 9)
Australian Economic Review     Hybrid Journal   (Followers: 6, SJR: 0.357, h-index: 21)
Australian Endodontic J.     Hybrid Journal   (Followers: 3, SJR: 0.513, h-index: 24)
Australian J. of Agricultural and Resource Economics     Hybrid Journal   (Followers: 3, SJR: 0.765, h-index: 36)
Australian J. of Grape and Wine Research     Hybrid Journal   (Followers: 5, SJR: 0.879, h-index: 56)
Australian J. of Politics & History     Hybrid Journal   (Followers: 13, SJR: 0.203, h-index: 14)
Australian J. of Psychology     Hybrid Journal   (Followers: 17, SJR: 0.384, h-index: 30)
Australian J. of Public Administration     Hybrid Journal   (Followers: 388, SJR: 0.418, h-index: 29)
Australian J. of Rural Health     Hybrid Journal   (Followers: 4, SJR: 0.43, h-index: 34)
Australian Occupational Therapy J.     Hybrid Journal   (Followers: 66, SJR: 0.59, h-index: 29)
Australian Psychologist     Hybrid Journal   (Followers: 11, SJR: 0.331, h-index: 31)
Australian Veterinary J.     Hybrid Journal   (Followers: 19, SJR: 0.459, h-index: 45)
Autism Research     Hybrid Journal   (Followers: 31, SJR: 2.126, h-index: 39)
Autonomic & Autacoid Pharmacology     Hybrid Journal   (SJR: 0.371, h-index: 29)
Banks in Insurance Report     Hybrid Journal   (Followers: 1)
Basic & Clinical Pharmacology & Toxicology     Hybrid Journal   (Followers: 10, SJR: 0.539, h-index: 70)
Basic and Applied Pathology     Open Access   (Followers: 2, SJR: 0.113, h-index: 4)
Basin Research     Hybrid Journal   (Followers: 3, SJR: 1.54, h-index: 60)
Bauphysik     Hybrid Journal   (Followers: 2, SJR: 0.194, h-index: 5)
Bauregelliste A, Bauregelliste B Und Liste C     Hybrid Journal  
Bautechnik     Hybrid Journal   (Followers: 1, SJR: 0.321, h-index: 11)
Behavioral Interventions     Hybrid Journal   (Followers: 9, SJR: 0.297, h-index: 23)
Behavioral Sciences & the Law     Hybrid Journal   (Followers: 23, SJR: 0.736, h-index: 57)
Berichte Zur Wissenschaftsgeschichte     Hybrid Journal   (Followers: 9, SJR: 0.11, h-index: 5)
Beton- und Stahlbetonbau     Hybrid Journal   (Followers: 2, SJR: 0.493, h-index: 14)
Biochemistry and Molecular Biology Education     Hybrid Journal   (Followers: 6, SJR: 0.311, h-index: 26)
Bioelectromagnetics     Hybrid Journal   (Followers: 1, SJR: 0.568, h-index: 64)
Bioengineering & Translational Medicine     Open Access  
BioEssays     Hybrid Journal   (Followers: 10, SJR: 3.104, h-index: 155)
Bioethics     Hybrid Journal   (Followers: 14, SJR: 0.686, h-index: 39)
Biofuels, Bioproducts and Biorefining     Hybrid Journal   (Followers: 1, SJR: 1.725, h-index: 56)
Biological J. of the Linnean Society     Hybrid Journal   (Followers: 14, SJR: 1.172, h-index: 90)
Biological Reviews     Hybrid Journal   (Followers: 3, SJR: 6.469, h-index: 114)
Biologie in Unserer Zeit (Biuz)     Hybrid Journal   (Followers: 42, SJR: 0.12, h-index: 1)
Biology of the Cell     Full-text available via subscription   (Followers: 9, SJR: 1.812, h-index: 69)
Biomedical Chromatography     Hybrid Journal   (Followers: 6, SJR: 0.572, h-index: 49)
Biometrical J.     Hybrid Journal   (Followers: 5, SJR: 0.784, h-index: 44)
Biometrics     Hybrid Journal   (Followers: 36, SJR: 1.906, h-index: 96)
Biopharmaceutics and Drug Disposition     Hybrid Journal   (Followers: 10, SJR: 0.715, h-index: 44)
Biopolymers     Hybrid Journal   (Followers: 18, SJR: 1.199, h-index: 104)
Biotechnology and Applied Biochemistry     Hybrid Journal   (Followers: 45, SJR: 0.415, h-index: 55)
Biotechnology and Bioengineering     Hybrid Journal   (Followers: 135, SJR: 1.633, h-index: 146)
Biotechnology J.     Hybrid Journal   (Followers: 13, SJR: 1.185, h-index: 51)
Biotechnology Progress     Hybrid Journal   (Followers: 39, SJR: 0.736, h-index: 101)
Biotropica     Hybrid Journal   (Followers: 18, SJR: 1.374, h-index: 71)
Bipolar Disorders     Hybrid Journal   (Followers: 10, SJR: 2.592, h-index: 100)
Birth     Hybrid Journal   (Followers: 34, SJR: 0.763, h-index: 64)
Birth Defects Research Part A : Clinical and Molecular Teratology     Hybrid Journal   (Followers: 2, SJR: 0.727, h-index: 77)
Birth Defects Research Part B: Developmental and Reproductive Toxicology     Hybrid Journal   (Followers: 5, SJR: 0.468, h-index: 47)
Birth Defects Research Part C : Embryo Today : Reviews     Hybrid Journal   (SJR: 1.513, h-index: 55)

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Journal Cover Annals of Noninvasive Electrocardiology
  [SJR: 0.531]   [H-I: 38]   [2 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1082-720X - ISSN (Online) 1542-474X
   Published by John Wiley and Sons Homepage  [1584 journals]
  • Issue Information
    • PubDate: 2017-07-17T06:42:06.359347-05:
      DOI: 10.1111/anec.12410
  • Congenital Long QT syndrome and torsade de pointes
    • Authors: Nabil El-Sherif; Gioia Turitto, Mohamed Boutjdir
      Abstract: Since its initial description by Jervell and Lange-Nielsen in 1957, the congenital long QT syndrome (LQTS) has been the most investigated cardiac ion channelopathy. A prolonged QT interval in the surface electrocardiogram is the sine qua non of the LQTS and is a surrogate measure of the ventricular action potential duration (APD). Congenital as well as acquired alterations in certain cardiac ion channels can affect their currents in such a way as to increase the APD and hence the QT interval. The inhomogeneous lengthening of the APD across the ventricular wall results in dispersion of APD. This together with the tendency of prolonged APD to be associated with oscillations at the plateau level, termed early afterdepolarizations (EADs), provides the substrate of ventricular tachyarrhythmia associated with LQTS, usually referred to as torsade de pointes (TdP) VT. This review will discuss the genetic, molecular, and phenotype characteristics of congenital LQTS as well as current management strategies and future directions in the field.
      PubDate: 2017-07-02T23:15:41.442398-05:
      DOI: 10.1111/anec.12481
  • The sensitivity of 38 heart rate variability measures to the addition of
           artifact in human and artificial 24-hr cardiac recordings
    • Authors: Nicolas J. C. Stapelberg; David L. Neumann, David H. K. Shum, Harry McConnell, Ian Hamilton-Craig
      Abstract: BackgroundArtifact is common in cardiac RR interval data derived from 24-hr recordings and has a significant impact on heart rate variability (HRV) measures. However, the relative impact of progressively added artifact on a large group of commonly used HRV measures has not been assessed. This study compared the relative sensitivity of 38 commonly used HRV measures to artifact to determine which measures show the most change with increasing increments of artifact. A secondary aim was to ascertain whether short-term and long-term HRV measures, as groups, share similarities in their sensitivity to artifact.MethodsUp to 10% of artifact was added to 20 artificial RR (ARR) files and 20 human cardiac recordings, which had been assessed for artifact by a cardiac technician. The added artifact simulated deletion of RR intervals and insertion of individual short RR intervals. Thirty-eight HRV measures were calculated for each file. Regression analysis was used to rank the HRV measures according to their sensitivity to artifact as determined by the magnitude of slope.ResultsRMSSD, SDANN, SDNN, RR triangular index and TINN, normalized power and relative power linear measures, and most nonlinear methods examined are most robust to artifact.ConclusionShort-term time domain HRV measures are more sensitive to added artifact than long-term measures. Absolute power frequency domain measures across all frequency bands are more sensitive than normalized and relative frequency domain measures. Most nonlinear HRV measures assessed were relatively robust to added artifact, with Poincare plot SD1 being most sensitive.
      PubDate: 2017-07-02T23:15:34.316947-05:
      DOI: 10.1111/anec.12483
  • A rare form of extremely wide QRS complex due to reversed homologous
           electrical ventricular separation of acute heart failure
    • Authors: Sujuan Yan; Jianhua Yu, Zhen Xia, Bo Zhu, Jinzhu Hu, Juxiang Li
      Abstract: Electrical ventricular separation, as a special complete intraventricular block, denotes that ventricles be electrically separated into two or more parts caused by severe and wide damage of myocardium and conduction. Electrical ventricular separation can be divided into homologous and heterologous, homologous electrical ventricular separation is a rare phenomenon, literally the excitement of whole ventricle originate from supraventricle, on ECG, there are two different QRS waves which connect with an isoelectric line, one ST segment and T wave. We report a valve heart disease presented with complicated electrophysiological characteristics, which has reversed complex homologous electrical ventricular separation with second degree intraventricular block.
      PubDate: 2017-06-29T01:55:27.544786-05:
      DOI: 10.1111/anec.12482
  • The association of QT interval components with atrial fibrillation
    • Authors: Nikhil Patel; Wesley T. O'Neal, S. Patrick Whalen, Elsayed Z. Soliman
      Abstract: BackgroundAlthough abnormalities of the QT interval are associated with atrial fibrillation (AF), it is unclear whether ventricular depolarization (QRS duration) or repolarization (JT interval) is a more important marker of AF risk.MethodsThis analysis included 4,181 (95% white; 59% women) participants from the Cardiovascular Health Study (CHS) who were free of baseline AF and major intraventricular delay. A linear scale was used to compute heart rate adjusted QT (QTa), QRS (QRSa), and JT (JTa) intervals. Prolonged QTa, QRSa, and JTa were defined by values greater than the sex-specific 95th percentile for each measurement. AF events were ascertained during the annual study electrocardiograms and from hospitalization discharge data. Cox regression was used to compute hazard ratios (HR) and 95% confidence intervals (CI) for the associations of prolonged QTa, QRSa, and JTa with AF, separately.ResultsOver a mean follow-up of 12.1 years, a total of 1,236 (30%) AF events were detected. An increased risk of AF (HR = 1.50. 95% CI = 1.20, 1.88) was observed with prolonged QTa. When we examined the association between individual components of the QTa interval and AF, the risk of AF was limited to prolonged JTa (HR = 1.31, 95% CI = 1.04, 1.65) and not prolonged QRSa (HR = 1.00, 95% CI = 0.77, 1.30). Similar results were obtained per 1-SD increase in QTa (HR = 1.07, 95% CI = 1.01, 1.13), QRSa (HR = 0.99, 95% CI = 0.94, 1.06), and JTa (HR = 1.07, 95% CI = 1.01, 1.13).ConclusionsThe JT interval is a more important marker of AF risk in the QT interval among persons who do not have ventricular conduction delays.
      PubDate: 2017-06-29T01:50:23.369648-05:
      DOI: 10.1111/anec.12467
  • Ranolazine reduces repolarization heterogeneity in symptomatic patients
           with diabetes and non–flow-limiting coronary artery stenosis
    • Authors: Ederson Evaristo; Fernando G. Stocco, Nishant R. Shah, Michael K. Cheezum, Jon Hainer, Courtney Foster, Bruce D. Nearing, Marcelo Di Carli, Richard L. Verrier
      Abstract: BackgroundExperimental evidence suggests that ranolazine decreases susceptibility to ischemia-induced arrhythmias independent of effects on coronary artery blood flow.ObjectiveIn symptomatic diabetic patients with non–flow-limiting coronary artery stenosis with diffuse atherosclerosis and/or microvascular dysfunction, we explored whether ranolazine reduces T-wave heterogeneity (TWH), an electrocardiographic (ECG) marker of arrhythmogenic repolarization abnormalities shown to predict sudden cardiac death.MethodsWe studied all 16 patients with analyzable ECG recordings during rest and exercise tolerance testing before and after 4 weeks of ranolazine in the double-blind, crossover, placebo-controlled RAND-CFR trial (NCT01754259). TWH was quantified without knowledge of treatment assignment by second central moment analysis, which assesses the interlead splay of T waves in precordial leads about a mean waveform. Myocardial blood flow (MBF) was measured by positron emission tomography.ResultsAt baseline, prior to randomization, TWH during rest was 54 ± 7 μV and was not altered following placebo (47 ± 6 μV, p = .47) but was reduced by 28% (to 39 ± 5 μV, p = .002) after ranolazine. Ranolazine did not increase MBF at rest. Exercise increased TWH after placebo by 49% (to 70 ± 8 μV, p = .03). Ranolazine did not reduce TWH during exercise (to 75 ± 16 μV), and there were no differences among the groups (p = .95, ANOVA). TWH was not correlated with MBF at rest before (r2 = .07, p = .36) or after ranolazine (r2 = .23, p = .06).ConclusionsIn symptomatic diabetic patients with non-flow-limiting coronary artery stenosis with diffuse atherosclerosis and/or microvascular dysfunction, ranolazine reduced TWH at rest but not during exercise. Reduction in repolarization abnormalities appears to be independent of alterations in MBF.
      PubDate: 2017-06-27T02:17:53.073178-05:
      DOI: 10.1111/anec.12480
  • Asystole caused by Hydroxycut Hardcore: A case report and literature
    • Authors: Julie Zaidan; Rabih Tabet, Boutros Karam, Farshid Daneshvar, Mohammed Raza, Soad Bekheit
      Abstract: Obesity is a rising epidemic worldwide driving people to search for remedy through nonconventional therapies. Hydroxycut products are popular supplements used as weight loss aids. Many reports revealed serious adverse effects related to their ingestion. We report the case of a 37-year-old healthy male patient who presented following an episode of syncope. On telemetry, he manifested recurrent sinus node arrests, including a symptomatic 24 s sinus pause. The patient admitted to taking Hydroxycut Hardcore for 10 days previously. After discontinuation of the drug, his symptoms completely resolved. This is the first case of Hydroxycut-associated syncope secondary to bradyarrhythmia.
      PubDate: 2017-06-27T01:32:34.696777-05:
      DOI: 10.1111/anec.12479
  • Bigeminal sandwiches galore
    • Authors: Thomas Lindow; Angelica Niklasson, Daniel Manna, Olle Pahlm
      Abstract: A long run of PVCs “sandwiched” in between the sinus beats resulting in an almost doubling of the heart rate—interpolated PVCs in bigeminy—is described. This case illustrates three interesting aspects of interpolated PVCs. Although they are not uncommon, long runs of interpolated PVCs in bigeminy are rare findings. In this case, the arrhythmia had a duration of 3 minutes. Second, it illustrates the “age-old wisdom” of partial retrograde conduction. Also, even though the arrhythmia resulted in an almost doubling of the heart rate, the patient remained asymptomatic.
      PubDate: 2017-06-27T01:28:07.545128-05:
      DOI: 10.1111/anec.12484
  • Response to Letter: Novel Electrocardiographic Indices of Arrhythmogenesis
           and Blood Lead Level
    • Authors: Ugur Nadir Karakulak; Engin Tutkun
      PubDate: 2017-06-21T23:15:48.258285-05:
      DOI: 10.1111/anec.12478
  • ECG-derived Cheyne-Stokes respiration and periodic breathing in healthy
           and hospitalized populations
    • Authors: Adelita Tinoco; Barbara J. Drew, Xiao Hu, David Mortara, Bruce A. Cooper, Michele M. Pelter
      Abstract: BackgroundCheyne-Stokes respiration (CSR) has been investigated primarily in outpatients with heart failure. In this study we compare CSR and periodic breathing (PB) between healthy and cardiac groups.MethodsWe compared CSR and PB, measured during 24 hr of continuous 12-lead electrocardiographic (ECG) Holter recording, in a group of 90 hospitalized patients presenting to the emergency department with symptoms suggestive of acute coronary syndrome (ACS) to a group of 100 healthy ambulatory participants. We also examined CSR and PB in the 90 patients presenting with ACS symptoms, divided into a group of 39 (43%) with confirmed ACS, and 51 (57%) with a cardiac diagnosis but non-ACS. SuperECG software was used to derive respiration and then calculate CSR and PB episodes from the ECG Holter data. Regression analyses were used to analyze the data. We hypothesized SuperECG software would differentiate between the groups by detecting less CSR and PB in the healthy group than the group of patients presenting to the emergency department with ACS symptoms.ResultsHospitalized patients with suspected ACS had 7.3 times more CSR episodes and 1.6 times more PB episodes than healthy ambulatory participants. Patients with confirmed ACS had 6.0 times more CSR episodes and 1.3 times more PB episodes than cardiac non-ACS patients.ConclusionContinuous 12-lead ECG derived CSR and PB appear to differentiate between healthy participants and hospitalized patients.
      PubDate: 2017-06-15T02:35:24.624942-05:
      DOI: 10.1111/anec.12462
  • Electrical storm in a patient with Duchenne muscular dystrophy
           cardiomyopathy triggered by abrupt β-blocker interruption
    • Authors: Nikolaos Fragakis; Melani Sotiriadou, Lydia Krexi, Vassilios Vassilikos
      Abstract: We present a case of a young man with Duchenne muscular dystrophy cardiomyopathy (DMDC) having an implantable cardioverter defibrillator for secondary prevention, who presented with electrical storm shortly after β-blocker interruption. The patient was stabilized and remained free of ventricular arrhythmias soon after reinitiating b-adrenoreceptor antagonists. The present case highlights the importance of sympathetic blockage in patients with DMDC due to existing pathophysiology of excess diastolic Ca2+ leak from sarcoplasmic reticulum as a result of ryanodine receptor dysfunction.
      PubDate: 2017-06-15T02:31:57.793847-05:
      DOI: 10.1111/anec.12477
  • Brugada syndrome, Brugada phenocopy or none'
    • Authors: Umut Kocabas; Can Hasdemir, Esra Kaya, Cuneyt Turkoglu, Adrian Baranchuk
      Abstract: Brugada syndrome is a form of inherited arrhythmia syndrome characterized by a distinct ST-segment elevation in the right precordial leads. Brugada phenocopies are clinical entities that present with an electrocardiographic pattern identical to Brugada syndrome and may obey to various clinical conditions. We present a case of a suicidal attempt using a high dose of propafenone causing a Brugada-type electrocardiographic pattern. Is this a Brugada syndrome case, a Brugada phenocopy or something else'
      PubDate: 2017-06-13T02:21:01.174389-05:
      DOI: 10.1111/anec.12470
  • New insights into the clinical signs of supraventricular tachycardia: The
           “sign of lace-tying”
    • Authors: Dominique Blommaert; Fabien Dormal, Olivier Deceuninck, Olivier Xhaet, Elisabeth Ballant, Luc De Roy
      Abstract: BackgroundSupraventricular tachycardias (SVT) are a common arrhythmia therefore an accurate diagnosis is of clinical importance. Although an ECG performed during tachycardia greatly aids diagnosis, patient history and predisposing factors also improve diagnostic accuracy.MethodsThis prospective study included 100 consecutive patients undergoing electrophysiological study for SVT with the aim to reassess their clinical characteristics and describe frequent predisposing factors, such as the “sign of lace-tying” that to our knowledge has not previously been reported. Each patient completed an extensive questionnaire (70 questions) during their hospital stay.ResultsOur series comprised: 67% of patients with atrioventricular nodal reentrant tachycardia (AVNRT); 24% with an accessory pathway; and 9% presented atrial tachycardia. Half of the population were male and 29% of the cohort presented hypertension. Syncope during tachycardia appeared in 15% of patients, dizziness in 52% and thoracic pain in 59%. We encountered a predisposing risk factor for SVT in 53% of cases; with 32% exhibiting an anteflexion of the trunk termed the “sign of lace-tying.” Data also showed that younger patients tended to present AVRT and regular pounding in the neck appeared only in patients with AVNRT.ConclusionsOverall, our study has highlighted the importance of considering clinical signs and patient characteristics both before and during SVT for the precise diagnosis of paroxysmal SVT. Furthermore, 32% of patients presented the “sign of lace-tying” or body position change before SVT, implying a diagnosis of SVT.
      PubDate: 2017-06-08T01:00:51.540362-05:
      DOI: 10.1111/anec.12471
  • Inhibition of left ventricular stimulation due to left ventricular lead
           failure and the left ventricular T-wave protection algorithm in patient
           with cardiac resynchronization therapy and pacemaker dependency
    • Authors: Andrzej Ząbek; Barbara Małecka, Maciej Dębski, Krzysztof Boczar, Jacek Lelakowski
      Abstract: The electrocardiogram (ECG) interpretation in patients with cardiac resynchronization therapy (CRT) is often a perplexing problem. The difficulty in the device evaluation increases in the presence of unfamiliar timing cycles and a lead dysfunction.
      Authors describe a special function of a Biotronik CRT devices called the left ventricle T-wave protection (LVTP), and demonstrate its behavior in a patient with left ventricular (LV) lead failure. This report shows that sometimes it might be difficult to understand the loss of resynchronization in 12-lead ECG when LVTP feature is on, and a malfunction of left ventricular lead sensing occurs.
      PubDate: 2017-06-08T00:35:47.01899-05:0
      DOI: 10.1111/anec.12473
  • QT interval measurements in patients with left bundle branch block. There
           is yet more to learn about repolarization
    • Authors: Harilaos Bogossian; Gerrit Frommeyer, Markus Zarse
      PubDate: 2017-06-07T05:40:22.235396-05:
      DOI: 10.1111/anec.12475
  • Reply to “letter to the editor: Is obesity related to postexercise
           cardiac autonomic recovery'”
    • Authors: Sahar M. El Agaty; Azra Kirmani, Ezaz Labban
      PubDate: 2017-06-07T05:40:18.483246-05:
      DOI: 10.1111/anec.12476
  • Effects of intranasal kinetic oscillation stimulation on heart rate
    • Authors: Markus Jerling; Iwona Cygankiewicz, Nabil Al-Tawil, Borje Darpo, Anders Ljungström, Wojciech Zareba
      Abstract: BackgroundKinetic oscillation stimulation in the nasal cavity (KOS) has been shown to have positive symptomatic effects in subjects with non-allergic rhinitis and in patients with migraine.MethodsTo evaluate the effect of KOS on autonomic function, we assessed heart rate variability (HRV) in this small exploratory study in 12 healthy subjects. KOS treatment was performed using a minimally invasive system with a single-use catheter inserted into the nasal cavity. During treatment, the tip was inflated and oscillated with a mean pressure of 95 millibar and amplitude of the oscillations of 100 millibar at a frequency of 68 Hz. Treatment was given for 15 minutes sequentially on each side. Heart rate variability was assessed during five 30-minutes periods before, during and immediately after KOS treatment and 3.5 hours thereafter. KOS resulted in a substantial reduction of HRV.ResultsAs compared to baseline recorded during 30 minutes preceding treatment, VLF was reduced by 65%, LF by 55%, the ratio LF/HF by 44%, with somewhat smaller observed effects in the time domain; SDNN and RMSDD were reduced by of 36% and 18%, respectively. Heart rate remained stable during treatment with minimal mean changes from 68 ± 7 bpm before to 68 ± 9 and 69 ± 9 bpm during and after treatment. Reduction of HRV parameters was consistently seen in all subjects, with rapid onset and return towards baseline values during post-treatment observation periods.ConclusionsKOS has an effect on the autonomic balance with pronounced heart-rate independent reduction on HRV.
      PubDate: 2017-06-07T05:35:27.452062-05:
      DOI: 10.1111/anec.12474
  • Changes in arrhythmogenic properties and five-year prognosis after
           carbon-ion radiotherapy in patients with mediastinum cancer
    • Authors: Mari Amino; Koichiro Yoshioka, Makiyoshi Shima, Tohru Okada, Mio Nakajima, Yoshiya Furusawa, Shigetaka Kanda, Sadaki Inokuchi, Teruhisa Tanabe, Yuji Ikari, Tadashi Kamada
      Abstract: IntroductionCarbon-ion irradiation of rabbit hearts has improved left ventricular conduction abnormalities through upregulation of gap junctions. However, to date, there has been no investigation on the effect of carbon-ion irradiation on electrophysiological properties in human. We investigated this effect in patients with mediastinum extra-cardiac cancer treated with carbon-ion radiotherapy that included irradiating the heart.Methods and ResultsIn April–December 2009, eight patients were prospectively enrolled (including two male, aged 72.5 ± 13.0 years). They were treated with 44–72 Gray equivalent (GyE), with their hearts exposed to 1.3–19.1 GyE. High-resolution ambulatory electrocardiography was performed before and after radiotherapy to investigate arrhythmic events, late potentials (LPs), and heart rate variability. Five patients had pre-existing premature ventricular contraction (PVC)/atrial contraction (PAC) or paroxysmal atrial fibrillation (PAF)/AF; after irradiation, this improved in four patients with PVC/PAF/AF and did not deteriorate in one patient with PAC. Ventricular LP findings did not deteriorate and improved in one patient. In eight cases with available atrial LP findings, there was no deterioration, and two patients showed improvements. The low frequency/high frequency ratio of heart rate variability improved or did not deteriorate in the six patients who received radiation exposure to the bilateral stellate ganglions. During the five-year follow-up for the prognosis, six of the eight patients died because of cancer; there was no history of hospitalization for cardiac events.ConclusionAlthough this preliminary study has several limitations, carbon-ion beam irradiation to the heart is not immediately cardiotoxic and demonstrates consistent signals of arrhythmia reduction.
      PubDate: 2017-06-07T05:30:52.318607-05:
      DOI: 10.1111/anec.12468
  • Repetitive ventricular tachycardia in a syncopal child: Cause or
           incidental finding '
    • Authors: Martial Massin; Caroline Jacquemart, Karim Khaldi
      Abstract: A 15-year-old girl suffered recurrent syncopal episodes during 7 years. Events were precipitated by exercise or emotional stress, leading to the diagnosis of reflex syncope. Exercise testing induced recurrent salvos of nonsustained right ventricular outflow tract tachycardia. This arrhythmia is often asymptomatic, reflex syncope is very frequent and both causes are related to the same triggering situations. It was therefore essential to obtain recordings during syncopal events and to observe the clinical evolution under effective treatment in order to make the right diagnosis.
      PubDate: 2017-05-30T01:05:40.903912-05:
      DOI: 10.1111/anec.12472
  • Progression of early repolarization patterns at a four year follow-up in a
           female flight crew population: Implications for aviation medicine
    • Authors: Gwénolé Rohel; Eric Perrier, Aurélien Delluc, Jonathan Monin, Olivier Manen, Philippe Paule, Marie Piquemal, Jacques Mansourati, Ulric Vinsonneau
      Abstract: BackgroundTo assess the prevalence, the appearance, and the distribution, as well as the fluctuation over time of early repolarization patterns after four years in a female population derived from the French aviation sector.MethodsThis was a retrospective longitudinal study from 1998 to 2010 of a population of female employees who received a full clinical examination and an electrocardiogram (ECG) upon their recruitment and after a period of four years.ResultsA total of 306 women were included (average of 25.87 ± 3.3 years of age). The prevalence of early repolarization was 9.2%. The most common appearance was J-point slurring for 64.3% (i.e. 20/28 subjects) that occurred in the inferior leads for 28.6% (i.e. 8/28 subjects). After four years, the prevalence was 7.5%, with a regression of this aspect in five of the subjects. There were no changes in the ECG in terms of the distribution and the appearance among the 23 subjects for whom the aspect persisted. Over the course of this four year period all of the subjects remained asymptomatic.ConclusionsEarly repolarization in this largely physically inactive female population was common, and it fluctuated over time. At present, no particular restrictions can be placed on asymptomatic flight crew who exhibit this feature in the absence of a prior medical history for heart disease.
      PubDate: 2017-05-30T01:00:26.28217-05:0
      DOI: 10.1111/anec.12451
  • Coronary sinus lead delay index for optimization of coronary sinus lead
    • Authors: Mevlüt Koç; Onur Kaypakli, Gökhan Gözübüyük, Durmus Yıldıray Şahin
      Abstract: AimOptimization of coronary sinus (CS) lead position to the latest activated left ventricular (LV) area is important to increase cardiac resynchronization therapy (CRT) response. We aimed to detect the relationship between coronary sinus lead delay index (CSDI) and echocardiographic, electrocardiographic response to CRT treatment.MethodsWe prospectively included 137 consecutive patients with heart failure (HF) diagnosis, QRS ≥ 120 ms, left bundle branch block (LBBB), New York Heart Association score (NYHA) II–IV, LV ejection fraction (LVEF)
      PubDate: 2017-05-30T00:52:52.077553-05:
      DOI: 10.1111/anec.12454
  • Rationale and design of a randomized trial to assess the safety and
           efficacy of MultiPoint Pacing (MPP) in cardiac resynchronization therapy:
           The MPP Trial
    • Authors: Gery Tomassoni; James Baker, Raffaele Corbisiero, Charles Love, David Martin, Robert Sheppard, Seth J. Worley, Kwangdeok Lee, Imran Niazi,
      Abstract: BackgroundAlthough the majority of Class III congestive heart failure (HF) patients treated with cardiac resynchronization therapy (CRT) show a clinical benefit, up to 40% of patients do not respond to CRT. This paper reports the design of the MultiPoint Pacing (MPP) trial, a prospective, randomized, double-blind, controlled study to evaluate the safety and efficacy of CRT using MPP compared to standard biventricular (Bi-V) pacing.MethodsA maximum of 506 patients with a standard CRT-D indication will be enrolled at up to 50 US centers. All patients will be implanted with a CRT-D system (Quartet LV lead Model 1458Q with a Quadra CRT-D, Abbott) that can deliver both MPP and Bi-V pacing. Standard Bi-V pacing will be activated at implant. At 3 months postimplant, patients in whom the echocardiographic parameters during MPP are equal or better than during Bi-V pacing are randomized (1:1) to either an MPP or Bi-V arm.ResultsThe primary safety endpoint is freedom from system-related complications at 9 months. Each patient's response to CRT will be evaluated using a heart-failure clinical composite score, consisting of a change in NYHA functional class, patient global assessment score, HF events, and cardiovascular death. The primary efficacy endpoint is the proportion of responders in the MPP arm compared with the Bi-V arm between 3 and 9 months.ConclusionThis trial seeks to evaluate whether MPP via a single quadripolar LV lead improves hemodynamic and clinical responses to CRT, both in clinical responders and nonresponders.
      PubDate: 2017-05-18T05:51:26.981888-05:
      DOI: 10.1111/anec.12448
  • Categorization and theoretical comparison of quantitative methods for
           assessing QT/RR hysteresis
    • Authors: Hugo Gravel; Daniel Curnier, Nagib Dahdah, Vincent Jacquemet
      Abstract: BackgroundIn the human electrocardiogram, there is a lag of adaptation of the QT interval to heart rate changes, usually termed QT/RR hysteresis (QT-hys). Subject-specific quantifiers of QT-hys have been proposed as potential biomarkers, but there is no consensus on the choice of the quantifier.MethodsA comprehensive literature search was conducted to identify original articles reporting quantifiers of repolarization hysteresis from the surface ECG in humans.ResultsSixty articles fulfilled our inclusion criteria. Reported biomarkers were grouped under four categories. A simple mathematical model of QT/RR loop was used to illustrate differences between the methods. Category I quantifiers use direct measurement of QT time course of adaptation. They are limited to conditions where RR intervals are under strict control. Category IIa and IIb quantifiers compare QT responses during consecutive heart rate acceleration and deceleration. They are relevant when a QT/RR loop is observed, typically during exercise and recovery, but are not robust to protocol variations. Category III quantifiers evaluate the optimum RR memory in dynamic QT/RR relationship modeling. They estimate an intrinsic memory parameter independent from the nature of RR changes, but their reliability remains to be confirmed when multiple memory parameters are estimated. Promising approaches include the differentiation of short-term and long-term memory and adaptive estimation of memory parameters.ConclusionModel-based approaches to QT-hys assessment appear to be the most versatile, as they allow separate quantification of QT/RR dependency and QT-hys, and can be applied to a wide range of experimental settings.
      PubDate: 2017-05-16T08:00:30.962647-05:
      DOI: 10.1111/anec.12463
  • Conventional and right-sided screening for subcutaneous ICD in a
           population with congenital heart disease at high risk of sudden cardiac
    • Authors: Pau Alonso; Joaquín Osca, Joaquín Rueda, Oscar Cano, Pedro Pimenta, Ana Andres, María José Sancho, Luis Martinez
      Abstract: BackgroundInformation regarding suitability for subcutaneous defibrillator (sICD) implantation in tetralogy of Fallot (ToF) and systemic right ventricle is scarce and needs to be further explored. The main objective of our study was to determine the proportion of patients with ToF and systemic right ventricle eligible for sICD with both, standard and right-sided screening methods. Secondary objectives were: (i) to study sICD eligibility specifically in patients at high risk of sudden cardiac death, (ii) to identify independent predictors for sICD eligibility, and (iii) to compare the proportion of eligible patients in a nonselected ICD population.MethodsWe recruited 102 patients with ToF, 33 with systemic right ventricle, and 40 consecutive nonselected patients. Conventional electrocardiographic screening was performed as usual. Right-sided alternative screening was studied by positioning the left-arm and right-arm electrodes 1 cm right lateral of the xiphoid midline. The Boston Scientific ECG screening tool was utilized.ResultsIn high-risk patients with ToF, eligibility was higher with right-sided screening in comparison with standard screening (61% vs. 44%; p = .018). Eligibility in high-risk right ventricle population was identical with both screening methods (77%, p = ns). The only independent predictor for sICD eligibility was QRS duration.ConclusionIn high-risk patients with ToF, right-sided implantation of the sICD could be an alternative to a conventional ICD. In patients with a systemic right ventricle, implantation of a sICD is an alternative to a conventional sICD.
      PubDate: 2017-05-15T23:45:33.288892-05:
      DOI: 10.1111/anec.12461
  • Predictors and implications of early left ventricular ejection fraction
           improvement in new-onset idiopathic nonischemic cardiomyopathy with narrow
           QRS complex: A NEOLITH substudy
    • Authors: Norman C. Wang; Evan C. Adelstein, Sandeep K. Jain, Stuart G. Mendenhall, Alaa A. Shalaby, Andrew H. Voigt, Samir Saba
      Abstract: BackgroundPredictors and implications of early left ventricular ejection fraction (LVEF) improvement with guideline-directed medical therapy (GDMT) in new-onset idiopathic nonischemic cardiomyopathy (NICM) with narrow QRS complex are not well described. The objectives were to describe predictors of LVEF improvement after 3 months on GDMT and adverse cardiac events based on post-GDMT LVEF status (≤35% vs.>35%).MethodsA retrospective cohort study was performed in subjects with new-onset NICM, LVEF ≤35%, and narrow QRS complex. Associations for baseline variables with post-GDMT LVEF improvement and absolute change in LVEF (∆LVEFGDMT) were assessed. Cox proportional hazards models assessed associations for post-GDMT LVEF status with adverse cardiac events.ResultsIn 70 subjects, 31 (44%) had post-GDMT LVEF ≤35% after a median follow-up time of 97.5 days (interquartile range, 84–121 days). In final multivariable models, severely dilated left ventricular end-diastolic diameter (LVEDD), compared with normal LVEDD, strongly predicted post-GDMT LVEF ≤35% (odds ratio, 7.77; 95% confidence interval [CI], 1.39–43.49; p = .02) and ∆LVEFGDMT (β = −15.709; standard error = 4.622; p = .001). Subjects with post-GDMT LVEF ≤35% were more likely to have adverse cardiac events over a median follow-up time of 970.5 days (unadjusted hazard ratio, 2.15; 95% CI, 0.93–4.96; p = .07). In the post-GDMT LVEF ≤35% group, 9 of 26 subjects (35%) had long-term LVEF > 35%.ConclusionIn new-onset NICM with narrow QRS complex, nondilated LVEDD predicted early LVEF improvement. Those with post-GDMT LVEF ≤35% had higher risk of adverse cardiac events, but a substantial proportion demonstrated continued long-term LVEF improvement.
      PubDate: 2017-05-12T06:06:26.868444-05:
      DOI: 10.1111/anec.12466
  • Gender equity imbalance in electrocardiology: A call to action
    • Authors: Erica Clarke Whalen; Grace Xu, Iwona Cygankiewicz, Ljuba Bacharova, Wojciech Zareba, Jonathan S. Steinberg, Larisa G. Tereshchenko, Adrian Baranchuk
      PubDate: 2017-05-12T05:21:03.080881-05:
      DOI: 10.1111/anec.12465
  • Beat-to-beat ECG restitution: A review and proposal for a new biomarker to
           assess cardiac stress and ventricular tachyarrhythmia vulnerability
    • Authors: Anthony A. Fossa
      Abstract: BackgroundCardiac restitution is the ability of the heart to recover from one beat to the next. Ventricular arrhythmia vulnerability can occur when the heart does not properly adjust to sudden changes in rate or in hemodynamics leading to excessive temporal and/or spatial heterogeneity in conduction or repolarization. Restitution has historically been used to study, by invasive means, the dynamics of the relationship between action potential duration (APD) and diastolic interval (DI) in sedated subjects using various pacing protocols. Even though the analogous measures of APD and DI can be obtained using the surface ECG to acquire the respective QT and TQ intervals for ECG restitution, this methodology has not been widely adopted for a number of reasons.MethodsRecent development of more advanced software algorithms enables ECG intervals to be measured accurately, on a continuous beat-to-beat basis, in an automated manner, and under highly dynamic conditions (i.e., ambulatory or exercise) providing information beyond that available in the typical resting state.ResultsCurrent breakthroughs in ECG technology will allow ECG restitution measures to become a practical approach for providing quantitative measures of the risks for ventricular arrhythmias as well as cardiac stress in general.ConclusionsIn addition to a review of the underlying principles and caveats of ECG restitution, a new approach toward an advancement of more integrated restitution biomarkers is proposed.
      PubDate: 2017-05-12T05:06:41.879349-05:
      DOI: 10.1111/anec.12460
  • Intermittent preexcitation indicates “a low-risk” accessory pathway:
           Time for a paradigm shift'
    • Authors: Marek Jastrzębski; Piotr Kukla, Maciej Pitak, Andrzej Rudziński, Adrian Baranchuk, Danuta Czarnecka
      Abstract: We report three patients with intermittent loss of the preexcitation pattern in the ECG that had undergone an electrophysiological study. Despite apparently poorly conducting accessory pathway (AP), in each case a fast anterograde conduction, either during spontaneous atrial fibrillation or during incremental atrial pacing (on isoproterenol) was documented; shortest preexcited RR intervals of 200–240 ms were observed. We review the literature and conclude that intermittent preexcitation observed on resting 12-lead ECG lacks sufficient specificity for the diagnosis of an AP with long refractory period and cannot be considered a substitute for electrophysiological study in patients with this electrocardiographical phenomenon.
      PubDate: 2017-05-12T04:50:50.734775-05:
      DOI: 10.1111/anec.12464
  • The exception to Marriot's sign
    • Authors: Vivek Reddy; Shanker Kundumadam, Pradeep Kathi, Kunwardeep Dhillon, Hibah Ismail, Gautam Anem
      Abstract: Differentiation of a wide complex arrhythmia can pose as a clinical challenge in the acute care setting. Two broad differentials exist including ventricular tachycardia versus supraventricular tachycardia with aberrancy, underlying bundle branch block or intrinsic conduction defect. To aid in distinguishing between supraventricular tachycardia and ventricular tachycardia, Brugada criteria is commonly used, albeit new algorithms have become more common. Marriott's sign, a taller peak in the first R wave when compared to R' is considered a specific criterion for distinguishing between these two entities and strongly favors the diagnosis of ventricular tachycardia. In this case we present a wide complex tachycardia, which is an exception to Marriott's sign.
      PubDate: 2017-05-03T05:10:26.972336-05:
      DOI: 10.1111/anec.12449
  • Impact of T wave amplitude in lead aVR on predicting cardiac events in
           ischemic and nonischemic cardiomyopathy patients with an implantable
           cardioverter defibrillator
    • Authors: Yoshihiro Tanaka; Tetsuo Konno, Yudai Tamura, Toyonobu Tsuda, Hiroshi Furusho, Masayuki Takamura, Kenji Sakata, Masakazu Yamagishi, Kenshi Hayashi
      Abstract: BackgroundT wave amplitudes during ventricular repolarization in the lead aVR (TAaVR) are shown to be associated with adverse cardiac events in patients with several cardiovascular diseases, such as postmyocardial infarction. However, the utility of TAaVR has not been previously evaluated in patients with cardiomyopathy who have received implantable cardioverter defibrillators (ICD). Patients with ischemic or nonischemic cardiomyopathy (ICM or NICM, respectively) and who received an ICD may experience worsening of their condition due to the introduction of electric shock during treatment. This study aimed to investigate the utility of TAaVR in the prediction of cardiac events in ICM or NICM patients with ICD.MethodsNinety-three consecutive ICM or NICM patients with ICD were retrospectively analyzed (median age: 64 years; male: 77.4%; ICD for secondary prevention: 76.3%; NICM: 64.5%). The median follow-up period was 31 months. The primary endpoint was defined as composite cardiac events, including cardiac death, major ventricular arrhythmic events (MVAE), or hospitalization due to heart failure (HHF).ResultsMultivariate Cox regression analysis demonstrated that less negative TAaVR (−0.1 mV ≤ TAaVR
      PubDate: 2017-04-25T06:10:42.104885-05:
      DOI: 10.1111/anec.12452
  • Is obesity related to postexercise cardiac autonomic recovery'
    • Authors: Wendell Arthur Lopes; Felipe de Oliveira Matos, Fernanda Errero Porto
      PubDate: 2017-04-25T06:10:36.177459-05:
      DOI: 10.1111/anec.12459
  • Impact of atrial fibrillation detected by extended monitoring—A
           population-based cohort study
    • Authors: Mathias C. Busch; Stefan Gross, Dietrich Alte, Jan A. Kors, Henry Völzke, Till Ittermann, André Werner, Anne Krüger, Raila Busch, Marcus Dörr, Stephan B. Felix
      Abstract: BackgroundThe clinical relevance of extended monitoring of AF in the general population is unclear. The study evaluated the detection of AF using transtelephonic electrocardiography and the clinical relevance of additional AF findings, especially with regard to stroke risk and mortality.MethodsThe data of 1678 volunteers participating in the tele-ECG-subproject of the Study of Health in Pomerania was evaluated. Occurrence of AF as revealed by tele-ECG and conventional ECG was evaluated. Associations with mortality, history of stroke, and other clinical parameters were analyzed.ResultsAF was detected in 21 subjects (1.3%) by conventional ECG (ECG-AF) and in 43 (2.6%) by tele-ECG. All individuals with AF revealed by conventional ECG were also diagnosed to have AF by tele-ECG; 22 were diagnosed by tele-ECG only (Tele-AF).During follow-up (median: 6.3 years) 42/1635, 1/22, and 5/21 participants died in the no-AF-, tele-AF-, and ECG-AF groups (p 
      PubDate: 2017-04-25T06:00:54.260803-05:
      DOI: 10.1111/anec.12453
  • A new modality for the estimation of corrected flow time via
           electrocardiography as an alternative to Doppler ultrasonography
    • Authors: Hooman Hossein-Nejad; Payam Mohammadinejad, Atefeh Zeinoddini, Seyedhossein Seyedhosseini Davarani, Mohsen Banaie
      Abstract: BackgroundEvaluation of corrected flow time (FTc) via ultrasonography is one of the suggested modalities for the assessment of intravascular volume status. This study aimed to compare the results of FTc of carotid artery measured via ultrasonography, as a measure of mechanical outcome of the cardiac cycle, with the results of FTc estimation from a new modified formula via electrocardiography (ECG), as a measure of electrical function of the cardiac cycle.MethodsHealthy volunteers were evaluated before and after a passive leg raising (PLR) maneuver. FTc was measured concurrently before and after PLR via a modified method from ECG and via ultrasonography of the carotid artery.ResultsA total number of 98 healthy volunteers (51 women and 47 men) with a mean age of 30.69 ± 6.28 years were included. There was a significant correlation between FTc measured by ultrasonography and estimated by ECG both before PLR and after PLR (r = .878, p 
      PubDate: 2017-04-22T02:25:33.269517-05:
      DOI: 10.1111/anec.12456
  • Scuba diving, patent foramen ovale and heart rhythm disturbances: The role
           of underwater Holter monitoring—Case report
    • Authors: Szymon Olędzki; Andrzej Wojtarowicz, Edyta Płońska-Gościniak, Maciej Lewandowski, Jarosław Gorący
      Abstract: Patent foramen ovale (PFO) is thought to be a risk factor for decompression illness (DCI). Catheter-based closure procedure reduces the risk of DCI in selected scuba divers with PFO. Major complication of invasive approach are rare, minor, especially heart rhythm disturbances are reported relatively often. We describe a case of 41-year-old diver, who underwent PFO closure due to recurrent DCI events. Afterward, he experienced no DCI symptoms; however, he complained about feeling of the heart beating during a submersion. Arrhythmia should be considered as a life-threatening for scuba diver, thus we performed underwater ECG monitoring and exclude the arrhythmia.
      PubDate: 2017-04-21T00:22:21.231888-05:
      DOI: 10.1111/anec.12450
  • Cutting off half of QRS duration can cause overcorrection of QT interval
           in left bundle branch block
    • Authors: Binhao Wang; Li Zhang, Yunlong Xia
      PubDate: 2017-04-21T00:22:14.355004-05:
      DOI: 10.1111/anec.12458
  • Automated T-wave analysis can differentiate acquired QT prolongation from
           congenital long QT syndrome
    • Authors: Alan Sugrue; Peter A. Noseworthy, Vaclav Kremen, J. Martijn Bos, Bo Qiang, Ram K. Rohatgi, Yehu Sapir, Zachi I. Attia, Peter Brady, Pedro J. Caraballo, Samuel J. Asirvatham, Paul A. Friedman, Michael J. Ackerman
      Abstract: BackgroundProlongation of the QT on the surface electrocardiogram can be due to either genetic or acquired causes. Distinguishing congenital long QT syndrome (LQTS) from acquired QT prolongation has important prognostic and management implications. We aimed to investigate if quantitative T-wave analysis could provide a tool for the physician to differentiate between congenital and acquired QT prolongation.MethodsPatients were identified through an institution-wide computer-based QT screening system which alerts the physician if the QTc ≥ 500 ms. ECGs were retrospectively analyzed with an automated T-wave analysis program. Congenital LQTS was compared in a 1:3 ratio to those with an identified acquired etiology for QT prolongation (electrolyte abnormality and/or prescription of known QT prolongation medications). Linear discriminant analysis was performed using 10-fold cross-validation to statistically test the selected features.ResultsThe 12-lead ECG of 38 patients with congenital LQTS and 114 patients with drug-induced and/or electrolyte-mediated QT prolongation were analyzed. In lead V5, patients with acquired QT prolongation had a shallower T wave right slope (−2,322 vs. −3,593 mV/s), greater T-peak-Tend interval (109 vs. 92 ms), and smaller T wave center of gravity on the x axis (290 ms vs. 310 ms; p 
      PubDate: 2017-04-21T00:16:10.852738-05:
      DOI: 10.1111/anec.12455
  • Electrocardiographic appearance of aortic stenosis before and after aortic
           valve replacement
    • Authors: Ivana I. Vranic
      Abstract: BackgroundSo far, the specific appearance of QRS complex, ST-segment, and T wave was observed in aortic stenosis (AS). S-wave dynamic change in leads V1–V3 was not reported in AS.MethodsIn a single-center, prospective study, we included a total number of 1.175 patients who underwent surgical aortic valve replacement (AVR). We conducted 3-year gathering of patients with symptomatic and asymptomatic severe AS, and separated them by hemodynamic stability into groups A and B, through EFLV (of more or less than 50%), AVA (of more or less than 0.9 cm2), PG (between 55 and 75 mm Hg or over 75 mm Hg), and end-diastolic LV dimension (of more or less than 56 mm). We evaluated the impact of S-wave magnitude in right precordial leads before and after AVR in all patients. We followed S-wave changes in electrocardiogram altogether with hemodynamic measurements derived from echocardiography.ResultsAnalysis of echocardiographic parameters, measured in patients before surgery, did not show statistical significance between asymptomatic and symptomatic group. The statistical significance was observed in the change in S-wave magnitude in the right precordial leads in both subsets of patients before AVR. We found statistically significant predictive value of S-wave magnitude in leads V2–V3 for dependent variables PG and end-diastolic LV dimension.ConclusionsS-wave changes in right precordial leads can predict increase in PG and critical narrowing of AVA, suggestive of timely referral for AVR.
      PubDate: 2017-04-21T00:16:08.35394-05:0
      DOI: 10.1111/anec.12457
  • The relationship between J waves and contact of lung cancer with the heart
    • Authors: Hideki Hayashi; Qi Wu, Minoru Horie
      Abstract: BackgroundJ waves result mainly from an increased density of transient outward current (Ito). Mechanical stretch to the heart activates multiple signal transduction pathways, in which Ito may be involved. The purpose of this study was to test the hypothesis that mechanical contact of lung cancer with the heart may manifest J waves.MethodsWe reviewed 12-lead electrocardiograms to examine whether J waves were associated with contact of lung cancer with the heart. J waves were defied as an elevation of ≥0.1 mV at the junction between QRS complex and ST segment with either notching or slurring morphology. The locational interaction between lung cancer and the heart was determined by computed tomography image.ResultsA total of 264 patients (176 men; mean 68.5 ± 10.7 years) with lung cancer were evaluated. The prevalence of J waves was 25.4% in the total population. J waves were present in 40 of 44 (90.9%) patients with the contact. In contrast, J waves were present in 25 of 220 (11.4%) patients without the contact. The sensitivity and specificity of the contact for J waves were 90.9% and 88.6%, respectively. The odds ratio of the contact with the heart to the presence of J waves was 78 (95% confidence interval 25.7–236.4). The appearance of J waves that coincided with the development of lung cancer was observed in 12 patients.ConclusionThe presence of J waves was associated with the contact of lung cancer with the heart.
      PubDate: 2017-03-16T00:01:29.931974-05:
      DOI: 10.1111/anec.12433
  • Evaluation of the ECG based Selvester scoring method to estimate
           myocardial scar burden and predict clinical outcome in patients with left
           bundle branch block, with comparison to late gadolinium enhancement CMR
    • Authors: Uzma Chaudhry; Pyotr G. Platonov, Robert Jablonowski, Jean-Philippe Couderc, Henrik Engblom, Xiajuang Xia, Björn Wieslander, Brett D. Atwater, David G. Strauss, Jesper Van der Pals, Martin Ugander, Marcus Carlsson, Rasmus Borgquist
      Abstract: BackgroundMyocardial scar burden quantification is an emerging clinical parameter for risk stratification of sudden cardiac death and prediction of ventricular arrhythmias in patients with left ventricular dysfunction. We investigated the relationships among semiautomated Selvester score burden and late gadolinium enhancement-cardiovascular magnetic resonance (LGE-CMR) assessed scar burden and clinical outcome in patients with underlying heart failure, left bundle branch block (LBBB) and implantable cardioverter-defibrillator (ICD) treatment.MethodsSelvester QRS scoring was performed on all subjects with ischemic and nonischemic dilated cardiomyopathy at Skåne University Hospital Lund (2002–2013) who had undergone LGE-CMR and 12-lead ECG with strict LBBB pre-ICD implantation.ResultsSixty patients were included; 57% nonischemic dilated cardiomyopathy and 43% ischemic cardiomyopathy with mean left ventricular ejection fraction of 27.6% ± 11.7. All patients had scar by Selvester scoring. Sixty-two percent had scar by LGE-CMR (n = 37). The Spearman correlation coefficient for LGE-CMR and Selvester score derived scar was r = .35 (p = .007). In scar negative LGE-CMR, there was evidence of scar by Selvester scoring in all patients (range 3%–33%, median 15%). Fourteen patients (23%) had an event during the follow-up period; 11 (18%) deaths and six adequate therapies (10%). There was a moderate trend indicating that presence of scar increased the risk of clinical endpoints in the LGE-CMR analysis (p = .045).ConclusionThere is a modest correlation between LGE-CMR and Selvester scoring verified myocardial scar. CMR based scar burden is correlated to clinical outcome, but Selvester scoring is not. The Selvester scoring algorithm needs to be further refined in order to be clinically relevant and reliable for detailed scar evaluation in patients with LBBB.
      PubDate: 2017-03-01T06:10:26.534916-05:
      DOI: 10.1111/anec.12440
  • Effects of exercise training intensity on cardiac autonomic regulation in
           habitual smokers
    • Authors: Choun-Sub Kim; Maeng-Kyu Kim, Hye-Young Jung, Mi-Ji Kim
      Abstract: BackgroundThe sympathoexcitatory effects of cigarette smoking cause an autonomic imbalance that may lead to cardiovascular disease. Aerobic training improves autonomic function by developing cardiorespiratory fitness; however, it is still uncertain whether aerobic training ameliorates the compromised autonomic modulation in smokers. This study aimed to investigate the effects of 8 weeks' aerobic training at different exercise intensities on autonomic regulation in habitual smokers.MethodsHealthy males (n = 34) were randomly assigned to a moderate-intensity aerobic training (MAT, 60% of heart rate reserve [HRR]), a high-intensity training group (HAT, 75% HRR), or a control group (CG). Training groups performed 8 weeks' aerobic training on a treadmill (3 times/week), but all subjects continued to smoke cigarettes as usual. Heart rate variability was monitored to evaluate the effect of aerobic training on autonomic regulation.ResultsAerobic training improved autonomic balance despite the continued smoking. In the time domain, rMSSD and pNN50 were significantly increased in HAT than in CG. On spectral analysis, the absolute and normalized units of high frequency (HF) were significantly increased in HAT, whereas the LF/HF ratio and the normalized unit of LF were significantly decreased compared to that in CG. SD1 and the SD1/SD2 ratio of the Poincaré plot analysis were significantly increased compared to CG. Although MAT showed a similar tendency to HAT in nonlinear indexes, there were no significant differences compared to CG.ConclusionAerobic training, particularly high-intensity training, increases the parasympathetic contribution to the sympathovagal system, leading to an improvement in autonomic balance despite continued cigarette smoking.
      PubDate: 2017-03-01T06:06:19.201585-05:
      DOI: 10.1111/anec.12434
  • Assessment of heart rate response to exercise and recovery during
           treadmill testing in arsenic-exposed workers
    • Authors: Ugur Nadir Karakulak; Meside Gunduzoz, Mehmet Ayturk, Mujgan Tek Ozturk, Engin Tutkun, Omer Hinc Yilmaz
      Abstract: BackgroundArsenic exposure is associated with various cardiovascular diseases. The aim of the present study was to assess cardiac autonomic function via heart rate response to exercise and recovery period of treadmill testing in arsenic-exposed workers.MethodsSixty-five (65) occupationally arsenic-exposed workers and 35 healthy controls were enrolled. Blood and urinary arsenic levels were analyzed and symptom limited maximal treadmill exercise test were performed. Chronotropic response to exercise including age-predicted maximal heart rate (APMHR), heart rate reserve (HRreserve), age-predicted HRreserve (APHRreserve) and adjusted HRreserve and 1st-, 2nd-and 3rd-min heart rate recovery (HRR) indices were calculated.ResultsBaseline clinical and echocardiographic parameters, exercise test duration, resting and maximal heart rate, peak exercise capacity, HRreserve, APMHR, APHRreserve, and adjusted HRreserve were found to be similar between groups. HRR1 (22.0 ± 4.3 vs. 24.3 ± 3.1 bpm, p = .003) and HRR2 (43.2 ± 6.2 vs. 46.7 ± 6.4 bpm, p = .012) were significantly lower in arsenic-exposed workers compared to controls. Blood and urinary arsenic levels negatively correlated with HRR1 (r = −.477, p 
      PubDate: 2017-03-01T00:35:52.382905-05:
      DOI: 10.1111/anec.12437
  • Antazoline—insights into drug-induced electrocardiographic and
           hemodynamic effects: Results of the ELEPHANT II substudy
    • Authors: Roman Piotrowski; Joanna Giebułtowicz, Jakub Baran, Agnieszka Sikorska, Dagmara Gralak-Łachowska, Małgorzata Soszyńska, Piotr Wroczyński, Piotr Kułakowski
      Abstract: BackgroundAntazoline is an old antihistaminic and new antiarrhythmic agent with unknown mechanisms of action which recently has been shown to effectively terminate atrial fibrillation. The aim of study was to examine the effects of antazoline on hemodynamic and ECG parameters.MethodsAntazoline was given intravenously in three 100 mg boluses to 10 healthy volunteers (four males, mean age 40 + 11 years). Hemodynamic and ECG parameters were measured using impedance cardiography [systolic (sBP), diastolic (dBP), mean (mBP) blood pressure, stroke volume (SV), cardiac output (CO), total peripheral resistance (TPR) and heart rate (HR), P wave, PR interval, QRS complex, QT and corrected QT (QTcF) interval]. Plasma concentration of antazoline was also measured.ResultsAntazoline caused significant prolongation of P wave, QRS as well as QT and QTcF (101 ± 10 vs 110 ± 16 ms, p 
      PubDate: 2017-02-25T02:20:28.443121-05:
      DOI: 10.1111/anec.12441
  • Selective use of the electrocardiogram in pediatric preparticipation
           athletic examinations among pediatric primary care providers
    • Authors: Bradley C. Clark; Joshua M. Hayman, Charles I. Berul, Kristin M. Burns, Jonathan R. Kaltman
      Abstract: ObjectivesRecent literature examining insurance administrative data suggests that a selective approach, with concurrent history and physical exam (H&P), for obtaining an electrocardiogram (ECG) as a part of a preparticipation examination (PPE) for pediatric athletes is commonly used in the primary care setting demonstrating a high rate of disease detection. We sought to understand practice patterns of providers with regard to usage of ECG as a part of PPE.MethodsUtilizing an online survey, we queried primary care providers regarding their practice patterns, rationale, and concerns regarding use of ECGs as a part of the PPE.ResultsA total of 125 pediatricians completed the survey; 73.7% selectively use the ECG, 24.6% never use the ECG, and only 1.7% always obtain an ECG as part of the PPE. The most common rationale for selectively or never using the ECG is the belief that the H&P is sufficient to identify cardiac disease (70%). The most common H&P findings that lead to ECG screening include chest pain or syncope with exertion, family history of sudden cardiac death, an irregular heart rate, and a diastolic murmur. Among the diseases associated with sudden cardiac death, most pediatricians fear missing hypertrophic cardiomyopathy.ConclusionBased on a survey of primary care providers, most practitioners are utilizing a selective approach of obtaining an ECG as a part of a PPE for athletic participation, which is in agreement with the current American Heart Association guidelines. Significant practice variation continues to exist, and may represent an area for future resource optimization.
      PubDate: 2017-02-21T00:15:24.667762-05:
      DOI: 10.1111/anec.12446
  • Successful use of sirolimus for refractory atrial ectopic tachycardia in a
           child with cardiac rhabdomyoma
    • Authors: Sanja Ninic; Marija Kalaba, Bosiljka Jovicic, Vladislav Vukomanovic, Sergej Prijic, Biljana Vucetic, Ruzica Kravljanac, Ana Vujic, Jovan Kosutic
      Abstract: Cardiac rhabdomyomas are common in tuberous sclerosis. We report a child who developed rhabdomyoma related arrhythmia refractory to antiarrhythmic drug therapy. Reversion of the atrial ectopic tachycardia was achieved with mammalian target of rapamycin pathway (mTOR) inhibitor sirolimus. As per our knowledge, this is the first time that sirolimus has been successfully used in this setting.
      PubDate: 2017-02-19T23:45:32.409675-05:
      DOI: 10.1111/anec.12435
  • Correlations between electrocardiogram and biomarkers in acute pulmonary
           embolism: Analysis of ZATPOL-2 Registry
    • Authors: Piotr Kukla; Dariusz A. Kosior, Andrzej Tomaszewski, Katarzyna Ptaszyńska-Kopczyńska, Katarzyna Widejko, Robert Długopolski, Andrzej Skrzyński, Piotr Błaszczak, Kamil Fijorek, Marcin Kurzyna
      Abstract: BackgroundElectrocardiography (ECG) is still one of the first tests performed at admission, mostly in patients (pts) with chest pain or dyspnea. The aim of this study was to assess the correlation between electrocardiographic abnormalities and cardiac biomarkers as well as echocardiographic parameter in patients with acute pulmonary embolism.MethodsWe performed a retrospective analysis of 614 pts. (F/M 334/280; mean age of 67.9 ± 16.6 years) with confirmed acute pulmonary embolism (APE) who were enrolled to the ZATPOL-2 Registry between 2012 and 2014.ResultsElevated cardiac biomarkers were observed in 358 pts (74.4%). In this group the presence of atrial fibrillation (p = .008), right axis deviation (p = .004), S1Q3T3 sign (p 
      PubDate: 2017-02-18T00:05:43.420171-05:
      DOI: 10.1111/anec.12439
  • Significance of a negative sinus P wave in lead V2 of the clinical
    • Authors: Rex N. MacAlpin
      Abstract: BackgroundA negative sinus P wave in lead V2 (NPV2) of the electrocardiogram (ECG) is rare when leads are positioned correctly. This study was undertaken to clarify the significance of an unusually high incidence of this anomaly found in ECGs at my institution.MethodsOne thousand four hundred thirty-five ECGs were randomly selected to determine the incidence and gender frequency in tracings showing positive (PPV2), and biphasic (BPV2) P waves in V2, as well as NPV2. To those cases with NPV2, 84 cases with that anomaly from earlier archived ECGs were added to give a larger group for analysis. Medical records were reviewed for clinical details and other archived ECGs.ResultsPPV2, BPV2, and NPV2 were found in 1,216 (84.5%), 150 (10.5%), and 69 cases (4.8%), respectively. Cases with NPV2 were more likely to be female (46 of 69 or 67.7%) than were those with either PPV2 (500 of 1,216 or 41.1%; p 
      PubDate: 2017-02-18T00:00:26.904632-05:
      DOI: 10.1111/anec.12432
  • Novel method to assess intrinsic heart rate recovery in ambulatory ECG
           recordings tracks cardioprotective effects of chronic autonomic regulation
           therapy in patients enrolled in the ANTHEM-HF study
    • Authors: Gerrard M. Carlson; Imad Libbus, Badri Amurthur, Bruce H. KenKnight, Richard L. Verrier
      Abstract: BackgroundPostexercise heart rate recovery (HRR) is a powerful and independent predictor of mortality. Autonomic regulation therapy (ART) with chronic vagus nerve stimulation (VNS) has been shown to improve ventricular function in patients with chronic heart failure. However, the effect of ART on HRR in patients with heart failure remains unknown.MethodsA new measure involving quantification of intrinsic HRR was developed for 24-hr ambulatory ECG (AECG) recordings based on spontaneous heart rate changes observed during daily activity in patients with symptomatic heart failure and reduced ejection fraction. Intrinsic HRR values were compared in 21 patients enrolled in the ANTHEM-HF study (NCT01823887) before and after 12 months of chronic ART (10 Hz, 250 μs pulse width, 18% duty cycle, maximum tolerable current amplitude after 10 weeks of titration) and to values from normal subjects (PhysioNet database, n = 54).ResultsWith chronic ART, average intrinsic HRR was improved as indicated by a shortening of the rate-recovery time constant by 8.9% (from 12.3 ± 0.1 at baseline to 11.2 ± 0.1 s, p 
      PubDate: 2017-02-17T23:55:26.348496-05:
      DOI: 10.1111/anec.12436
  • Relationship between QT and JT peak interval variability in prepubertal
    • Authors: Yuka Takeuchi; Yumi Omeki, Kayo Horio, Miki Nishio, Rina Nagata, Shota Oikawa, Yuri Mizutani, Arisa Nagatani, Yuri Funamoto, Hidetoshi Uchida, Masayuki Fujino, Yoshihiko Eryu, Hiroko Boda, Masafumi Miyata, Tadayoshi Hata
      Abstract: BackgroundThe QT variability index (QTVI) is a noninvasive index of repolarization lability that has been applied to subjects with cardiovascular disease. QTVI provides a ratio of normalized QT variability to normalized heart rate variability, and therefore includes an assessment of autonomic nervous activity. However, measurement of QT time is particularly difficult in children, who exhibit physiologically high heart rates compared with adults. In this study, we developed a set of standard values of J-point to Tpeak interval (JTp) for infants by age, and assessed the correlation of QTVI with the JTp variability index (JTpVI).MethodsSubjects included 623 infants and children (0–7 years of age) without heart disease and 57 healthy university students. All subjects were divided into three groups by age. QTVI and JTpVI were calculated based on an electrocardiogram, and age-specific standard values, a gender-specific classification, and a standard growth curve were constructed.ResultsJTpVI markedly decreased in infancy and slowly decreased thereafter, reaching adult values by school age. There was also a strong correlation of JTpVI with QTVI (r = .856).ConclusionsJTp can be used to evaluate the variability of the repolarization time in healthy infants, and may be useful for detection of early repolarization abnormalities.
      PubDate: 2017-02-17T00:15:28.138289-05:
      DOI: 10.1111/anec.12444
  • Positive T wave in lead aVR as an independent predictor for 1-year major
           adverse cardiac events in patients with first anterior wall ST-segment
           elevation myocardial infarction
    • Authors: Akihiro Kobayashi; Naoki Misumida, Shunsuke Aoi, Yumiko Kanei
      Abstract: BackgroundPositive T wave in lead aVR has been shown to predict an adverse in-hospital outcome in patients with anterior wall ST-segment elevation myocardial infarction (STEMI). However, the prognostic value of positive T wave in lead aVR on a long-term outcome has not been fully explored.MethodsWe performed a retrospective analysis of 190 consecutive patients with first anterior wall STEMI who underwent an emergent coronary angiogram. Patients were divided into those with positive T wave > 0 mV and those with negative T wave ≦ 0 mV in lead aVR. Baseline and angiographic characteristics, and in-hospital revascularization procedures were recorded. In addition, in-hospital and 1-year major adverse cardiac events (MACE) including death, recurrent myocardial infarction, and target vessel revascularization were recorded.ResultsAmong 190 patients, 37 patients (19%) had positive T wave and 153 patients (81%) had negative T wave in lead aVR. Patients with positive T wave had higher rate of left main disease defined as stenosis ≥50% (11% vs. 2%, p = .028) than those with negative T wave. Patients with positive T wave had higher rate of 1-year MACE (38% vs. 13%, p 
      PubDate: 2017-02-16T01:15:28.652031-05:
      DOI: 10.1111/anec.12442
  • Sequence of cardiovascular autonomic alterations after fingolimod
    • Authors: Sakari Simula; Tomi P. Laitinen, Tiina M. Laitinen, Päivi Hartikainen, Juha E.K. Hartikainen
      Abstract: BackgroundHomeostasis between heart rate and blood pressure is based on several interacting regulatory reflexes, which become influenced by fingolimod initiation. The aim of this study was to determine the sequence of changes in cardiovascular autonomic regulation after fingolimod initiation.MethodsTwenty-seven patients with relapsing–remitting multiple sclerosis underwent continuous electrocardiogram recording during the first 6 hr after the first dose of fingolimod. In addition to the time interval between two consecutive R-peaks (RR interval), blood pressure and heart rate variability (HRV) were measured on hourly basis. Cardiac parasympathetic and sympathetic regulation were assessed by the different components of HRV.ResultsHRV demonstrated an enhancement in cardiac parasympathetic regulation starting 1 hr after the first dose of fingolimod. Blood pressure started to decrease 2 hr and sympathetic cardiac regulation 3 hr after fingolimod initiation. Recovery in RR interval, systolic and diastolic blood pressure, as well as in cardiac autonomic regulation started after 5 hr postdose, whereas pulse pressure (difference between systolic and diastolic blood pressure) continued to increase at the time of hospital discharge.ConclusionsRR interval, blood pressure, as well as the parasympathetic and sympathetic components of cardiac autonomic regulation alter sequentially in different temporal pattern after fingolimod initiation. These findings enhance the understanding of the effects of fingolimod initiation on cardiovascular autonomic regulation in real life.
      PubDate: 2017-02-13T04:15:32.042481-05:
      DOI: 10.1111/anec.12443
  • ECG in athlete: “Normal or pathologic variant'”
    • Authors: Helder Dores; António Freitas
      PubDate: 2017-02-13T03:35:24.509025-05:
      DOI: 10.1111/anec.12438
  • Idiopathic epicardial ventricular tachycardia from the coronary venous
           system: From electrocardiographic recognition to appropriate therapy
    • Authors: Stéphane Boulé; Claire Federspiel, Eric Verbrugge, Didier Klug
      Abstract: Idiopathic epicardial ventricular tachycardias (VTs) account for 9% of idiopathic VTs. The recognition of this entity is important, as a minimally invasive ablation procedure performed exclusively through the coronary sinus branches may be considered, avoiding the potential risks associated with access to the left ventricular endocardium, the aortic root, and the pericardial space. The electrocardiographic features and therapeutic management of this rare form of tachycardia are discussed.
      PubDate: 2017-02-11T01:40:30.044626-05:
      DOI: 10.1111/anec.12445
  • Sokolow-Lyon voltage is suitable for monitoring improvement in cardiac
    • Authors: Kenji Fukaya; Kyosuke Takeshita, Takahiro Okumura, Hiroaki Hiraiwa, Soichiro Aoki, Takeo Ichii, Yuki Sugiura, Katsuhide Kitagawa, Toru Kondo, Naoki Watanabe, Naoaki Kano, Kenji Furusawa, Akinori Sawamura, Ryota Morimoto, Yasuko Bando, Toyoaki Murohara
      Abstract: BackgroundThe clinical significance of electrocardiogram in the assessment of patients with idiopathic dilated cardiomyopathy (IDCM) is currently unknown. The aim of this study was to determine the feasibility of recording serial changes in Sokolow–Lyon voltage (∆%QRS-voltage) in one year to estimate left ventricular reverse remodeling (LVRR) and predict a prognosis of IDCM patients under tailored medical therapy.MethodsSixty-eight consecutive patients with mild symptoms (52.1 ± 13 years old; 69% men; NYHA I/II/III/IV; 33/29/6/0) underwent electrocardiography and echocardiography at baseline and 12 month follow-up (follow-up period: 3.9 years).ResultsLVRR was observed in 30 patients (44.1%). The ∆%QRS-voltage was significantly lower in the LVRR group (LVRR; −26.9%, non-LVRR: −9.2%, p 
      PubDate: 2017-02-03T05:05:25.811838-05:
      DOI: 10.1111/anec.12431
  • Cardiovascular magnetic resonance-GUIDEd management of mild to moderate
           left ventricular systolic dysfunction (CMR GUIDE): Study protocol for a
           randomized controlled trial
    • Authors: Joseph B. Selvanayagam; Trent Hartshorne, Laurent Billot, Suchi Grover, Graham S. Hillis, Werner Jung, Henry Krum, Sanjay Prasad, Andrew D. McGavigan
      Abstract: BackgroundThe majority of sudden cardiac death (SCD) in patients with heart failure occurs in those with mild-moderate left ventricular (LV) systolic dysfunction (LVEF 36–50%) who under current guidelines are ineligible for primary prevention implantable cardiac defibrillator (ICD) therapy. Recent data suggest that cardiac magnetic resonance (CMR) evidence of replacement fibrosis forms a substrate for malignant arrhythmia and therefore potentially identifies a subgroup at increased risk of SCD. Our hypothesis is that among patients with mild-moderate LV systolic dysfunction, a CMR-guided management strategy for ICD insertion based on the presence of scar or fibrosis is superior to a current strategy of standard care.Methods/DesignCMR GUIDE is a prospective, multicenter randomized control trial enrolling patients with mild-moderate LV systolic dysfunction and CMR evidence of fibrosis on optimal heart failure therapy. Participants will be randomized to receive either a primary prevention ICD or an implantable loop recorder (ILR). The primary endpoint is the time to SCD or hemodynamically significant ventricular arrhythmia (VF or VT) during an average 4-year follow-up. Secondary endpoints include quality of life assessed by Minnesota Living with Heart Failure Questionnaire, heart failure related hospitalizations, and a cost-utility analysis. Clinical identifier NCT01918215.DiscussionCMR GUIDE trial will add substantially to our understanding of the role of myocardial fibrosis and the risk of developing life-threatening ventricular arrhythmias. If the superiority of a CMR-guided approach over standard care is proven, it may change international clinical guidelines, with the potential to considerably increase survival in this growing patient population.
      PubDate: 2017-01-24T05:40:44.212169-05:
      DOI: 10.1111/anec.12420
  • Fibrillatory wave amplitude on transesophageal ECG as a marker of left
           atrial low-voltage areas in patients with persistent atrial fibrillation
    • Authors: Ran Yin; Yongnan Fu, Zhongming Yang, Bingong Li, Jintian Pen, Zeqi Zheng
      Abstract: BackgroundLow-voltage areas (LVAs) are frequently observed in patients with persistent atrial fibrillation (PeAF) and may represent adverse atrial remodeling. However, noninvasive method of evaluating LAVs is not well established.MethodsIn a cohort of 68 patients with PeAF, endocardial voltage maps of left atrium (LA) were created during sinus rhythm after pulmonary vein isolation (PVI). LVAs were defined as areas with electrogram amplitudes
      PubDate: 2017-01-16T00:05:26.715275-05:
      DOI: 10.1111/anec.12421
  • Repeatability of ectopic beats from 48-hr ambulatory electrocardiography:
           The Atherosclerosis Risk in Communities (ARIC) Study
    • Authors: Michelle L. Meyer; Elsayed Z. Soliman, Lisa M. Wruck, Thomas H. Mosley, Lynne E. Wagenknecht, Anna K. Poon, Eric A. Whitsel, Alvaro Alonso, Gerardo Heiss, Laura R. Loehr
      Abstract: BackgroundThe purpose of this study was to characterize the repeatability of ectopic beats, defined by premature atrial contractions (PACs) and premature ventricular contractions (PVCs), on ambulatory electrocardiogram (aECG) monitoring and evaluate the effect of length of aECG monitoring on the repeatability estimates.MethodsThis analysis includes 95 randomly selected participants from the Atherosclerosis Risk in Communities Study (ARIC; 2011–2013). The participants wore a Holter monitor for two, 48-hr periods separated by a mean of 38 days following an identical, standardized protocol. We divided each 48-hr recording into 3-, 6-, 12-, and 24-hr recording periods and calculated intraclass correlation coefficients (ICCs) for PACs and PVCs and also as a percentage of the corresponding total of recorded beats per hour among these periods.ResultsAll participants had ≥1 PAC during the 48-hr recordings, and only two participants had no PVCs. ICCs were>0.83 for all indices and recording lengths ≥12 hrs. ICCs were intermediate for 6-hr recordings (range 0.80–0.83) and lower for 3-hr recordings (range 0.74–0.80). The ratio of the between- to within-participant variation increased with recording length.ConclusionRepeatability of PACs and PVCs was excellent for recording lengths of 6–24 hr and fair for 3 hr. Repeatability varies over shorter duration recordings within the 48-hr recording period, and thus the present results have implications for detection algorithms for ectopic beats and can facilitate epidemiologic and clinical applications in which knowledge of measurement variability and misclassification are needed.
      PubDate: 2017-01-06T02:35:23.623127-05:
      DOI: 10.1111/anec.12426
  • The Romhilt-Estes electrocardiographic score predicts sudden cardiac
           arrest independent of left ventricular mass and ejection fraction
    • Authors: Navid Darouian; Aapo L. Aro, Kumar Narayanan, Audrey Uy-Evanado, Carmen Rusinaru, Kyndaron Reinier, Karen Gunson, Jonathan Jui, Sumeet S. Chugh
      Abstract: BackgroundThe Romhilt-Estes point score system (RE) is an established ECG criterion for diagnosing left ventricular hypertrophy (LVH). In this study, we assessed for the first time, whether RE and its components are predictive of sudden cardiac arrest (SCA) independent of left ventricular (LV) mass.MethodsSudden cardiac arrest (SCA) cases occurring between 2002 and 2014 in a Northwestern US metro region (catchment area approx. 1 million) were compared to geographic controls. ECGs and echocardiograms performed prior to the SCA and those of controls were acquired from the medical records and evaluated for the ECG criteria established in the RE score and for LV mass.ResultsTwo hundred forty-seven SCA cases (age 68.3 ± 14.6, male 64.4%) and 330 controls (age 67.4 ± 11.5, male 63.6) were included in the analysis. RE scores were greater in cases than controls (2.5 ± 2.1 vs. 1.9 ± 1.7, p 
      PubDate: 2017-01-03T01:10:40.416311-05:
      DOI: 10.1111/anec.12424
  • Initial electrocardiogram as determinant of hospital course in ST
           elevation myocardial infarction
    • Authors: Michael A. Millard; Vijaiganesh Nagarajan, Luke C. Kohan, Robert C. Schutt, Ellen C. Keeley
      Abstract: BackgroundA proportion of patients with ST elevation myocardial infarction (STEMI) have an initial electrocardiogram (ECG) that is nondiagnostic and are definitively diagnosed on a subsequent ECG. Our aim was to assess whether patients with a nondiagnostic initial ECG are different than those with a diagnostic initial ECG.MethodsWe collected demographic, ECG, medication, angiographic, and in-hospital clinical outcome data in consecutive patients undergoing primary percutaneous coronary intervention for STEMI at our institution from June 2009 to June 2013.ResultsA total of 334 patients were included, 285 (85%) diagnosed on the initial ECG and 49 (15%) on a subsequent ECG. Patients with a nondiagnostic initial ECG had more comorbidities including prior congestive heart failure (14% vs. 3%, p 
      PubDate: 2017-01-03T00:45:32.193465-05:
      DOI: 10.1111/anec.12429
  • Atrioventricular synchrony in the background of ventricular noise and
    • Authors: Paweł T. Matusik; Andrzej Ząbek, Patrycja S. Matusik, Barbara Małecka, Jacek Lelakowski
      Abstract: The 24-hr electrocardiogram (ECG) interpretation in patients with double-chamber pacemakers may be challenging. The difficulty increases if not well-known pacemaker algorithm and device malfunction coexist. We show atrial synchronization pace (ASP) in a patient with ventricular lead damage. We provide detailed description of electrocardiogram and intracardiac electrogram. ASP may confuse 24-hr ECG monitoring interpretation, especially in patients with ventricular lead dysfunction.
      PubDate: 2017-01-03T00:30:26.892652-05:
      DOI: 10.1111/anec.12425
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