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Further Advances in Electrocardiography, Cardiac Arrhythmias, and Arrhythmogenic Disorders
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Further Advances in Electrocardiography, Cardiac Arrhythmias, and Arrhythmogenic Disorders

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: 20 May 2025 | Viewed by 6653

Special Issue Editor

Dr. Paweł T. Matusik

E-Mail Website
Guest Editor
Department of Electrocardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, The John Paul II Hospital, Kraków, Poland
Interests: cardiac arrhythmias; arrhythmogenic disorders; atrial fibrillation; cardiac pacing; implantable cardioverter-defibrillators; cardiac resynchronization therapy; catheter ablation
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Novel electrocardiographic criteria, along with new algorithms for the diagnostics and treatment of arrhythmias, have been proposed, enabling more personalized patient management, including the more rational use of imaging, implantable cardioverter-defibrillators, cardiac resynchronization therapy, and catheter ablation. The progress also concerns the diagnostics, treatment, and classification of arrhythmogenic disorders. Moreover, advancements in imaging and cardiovascular genetics make better diagnostics and risk stratification possible; however, personalized paths in arrhythmia management are increasingly needed.

This Special Issue of the Journal of Clinical Medicine, “Further Advances in Electrocardiography, Cardiac Arrhythmias and Arrhythmogenic Disorders”, will focus on recent improvements, developments, and findings in the fields of diagnostics and the treatment of cardiac arrhythmias as well as arrhythmogenic disorders, including channelopathies and cardiomyopathies. Furthermore, papers summarizing the current state of knowledge, papers on arrhythmias related to specific diseases (e.g., sleep apnea) or disciplines, and those highlighting potential gaps in our understanding of cardiac arrhythmias are also welcome.  

It is my pleasure to invite you to contribute to this Special Issue. This is a new volume; we published 22 papers in the first volume. For more details, please visit the following link: https://www.mdpi.com/journal/jcm/special_issues/cardiac_arrhythmias_research.

Dr. Paweł T. Matusik
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • electrocardiography
  • cardiac arrhythmias
  • genetics
  • cardiac pacing
  • implantable cardioverter-defibrillators
  • cardiac resynchronization therapy
  • magnetic resonance imaging
  • catheter ablation
  • arrhythmogenic disorders
  • channelopathy
  • cardiomyopathy

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Related Special Issue

Published Papers (5 papers)

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16 pages, 1111 KiB  
Article
The Utility of Baseline Characteristics and [123I]MIBG Cardiac Adrenergic System Scintigraphy in Qualifying Patients with Post-Infarction Heart Failure for Implantable Cardioverter-Defibrillator (ICD) Placement
by Anna Teresińska, Aneta Fronczak-Jakubczyk, Olgierd Woźniak, Aleksander Maciąg, Jarosław Jezierski, Alicja Cicha-Mikołajczyk, Piotr Hoffman and Elżbieta Katarzyna Biernacka
J. Clin. Med. 2024, 13(21), 6378; https://doi.org/10.3390/jcm13216378 - 24 Oct 2024
Viewed by 812
Abstract
Background: Post-infarction heart failure with reduced ejection fraction (HFrEF) patients often face persistent risks of sudden cardiac arrest leading to sudden cardiac death. While implanting a cardioverter-defibrillator (ICD) can enhance prognosis, complications and costs limit its widespread use. Current patient qualification criteria, relying [...] Read more.
Background: Post-infarction heart failure with reduced ejection fraction (HFrEF) patients often face persistent risks of sudden cardiac arrest leading to sudden cardiac death. While implanting a cardioverter-defibrillator (ICD) can enhance prognosis, complications and costs limit its widespread use. Current patient qualification criteria, relying on imperfect parameters, require refinement. The impairment of the cardiac adrenergic system in heart failure is associated with ventricular arrhythmias. The goal of the study was to assess the utility of cardiac adrenergic system scintigraphy in qualifying patients for ICD placement. Methods: In this prospective study of 85 post-infarction HFrEF patients at a single center, clinical assessments, laboratory tests, echocardiography, [123I]MIBG scintigraphy, and ICD implantation were performed. Scintigraphy involved planar chest images and evaluating the heart-to-mediastinum ratio (H/M) and washout rate (WO). SPECT imaging assessed [123I]MIBG uptake in 17 left ventricular segments to calculate the summed difference score (SDS). Results: During a median of 4-year follow-up, 22% of patients experienced appropriate ICD interventions, and 25% of patients died or underwent heart transplantation. The mean values of analyzed parameters did not significantly differ between groups. In the univariate analysis, younger age and moderately impaired left ventricular ejection fraction (LVEF) were correlated with more frequent ICD interventions. In comparison, older age and elevated NT-proBNP levels were associated with death or heart transplantation. Additionally, the univariate analysis identified SDS-15′ as a prognostic factor for death/heart transplant. The multivariate analysis identified predictors for ICD interventions, including younger age, an EF of 30% or greater, and a larger left ventricular end-diastolic diameter. In contrast, older age and an LVEF of less than 25% were significant predictors of death or heart transplantation. Conclusions: Scintigraphic parameters did not effectively predict ICD interventions or death/heart transplantation, though the summed difference score demonstrated potential as a prognostic factor. Younger age with moderately impaired EF correlated with frequent ICD interventions, while in older age, EF < 25% predicted death or transplantation. Further investigation is needed for patients with borderline EF values. Full article
(This article belongs to the Special Issue Further Advances in Electrocardiography, Cardiac Arrhythmias, and Arrhythmogenic Disorders)
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11 pages, 1514 KiB  
Article
The Utility of a Resting Electrocardiogram (ECG-PH Index) in Evaluating the Efficacy of Pulmonary Endarterectomy in Chronic Thromboembolic Pulmonary Hypertension
by Michał Piłka, Szymon Darocha, Michał Florczyk, Rafał Mańczak, Marta Banaszkiewicz, Piotr Kędzierski, Dariusz Zieliński, Krzysztof Wróbel, Adam Torbicki and Marcin Kurzyna
J. Clin. Med. 2023, 12(24), 7621; https://doi.org/10.3390/jcm12247621 - 11 Dec 2023
Cited by 1 | Viewed by 1749
Abstract
Background: The ECG-PH index (PH-ECG score) has been proposed as a valuable ECG-derived method of evaluating the effectiveness of balloon pulmonary angioplasty (BPA) in chronic thromboembolic pulmonary hypertension (CTEPH). Pulmonary endarterectomy (PEA) is the main form of therapy for CTEPH with a proximal [...] Read more.
Background: The ECG-PH index (PH-ECG score) has been proposed as a valuable ECG-derived method of evaluating the effectiveness of balloon pulmonary angioplasty (BPA) in chronic thromboembolic pulmonary hypertension (CTEPH). Pulmonary endarterectomy (PEA) is the main form of therapy for CTEPH with a proximal clot location. The objective of this study was to assess the clinical utility of a resting electrocardiogram (ECG-PH index) in assessing the effectiveness of PEA in CTEPH patients. Methods: The retrospective analysis included 73 patients who underwent PEA. Their ECG-PH index values were calculated using four ECG parameters: R-wave amplitude V1 + S-wave amplitude V5/V6 > 10.5 mm, QRS-wave axis > 110 degrees, R-wave amplitude V1 > S-wave amplitude V1, and SIQIII pattern. PH-ECG scores were assessed after a median time of 13 months (IQR: 8–31 months) had passed since the PEA procedures. Results: The current analysis documented that ECG-PH index = 0 is a good reflection of mPAP < 25mmHg (sensitivity 76.1%; specificity 66.7%; positive predictive value 79.5%; negative predictive value 62.1%) or mPAP ≤ 20 mmHg (sensitivity 69.6%; specificity 70.6%; positive predictive value 88.6%; negative predictive value 41.4%) after PEA. The values of the area under the ROC curve for ECG-PH index were 0.772 (95% CI: 0.676–0.867) and 0.743 (95% CI: 0.637–0.849) for the mPAP < 25 mmHg and mPAP ≤ 20 mmHg patient groups, respectively. Conclusion: The ECG-PH index may be useful for monitoring the haemodynamic effect of PEA in CTEPH patients. Full article
(This article belongs to the Special Issue Further Advances in Electrocardiography, Cardiac Arrhythmias, and Arrhythmogenic Disorders)
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8 pages, 1300 KiB  
Case Report
Cardiac Arrest During Exertion as a Presentation of Undiagnosed Kawasaki Disease: A Case Report
by Justyna Zamojska, Piotr Kędziora, Agnieszka Januś, Krzysztof Kaczmarek and Elżbieta Smolewska
J. Clin. Med. 2024, 13(21), 6380; https://doi.org/10.3390/jcm13216380 - 24 Oct 2024
Viewed by 876
Abstract
Background: Kawasaki Disease (KD) is self-limited vasculitis, the main consequence of which may be involvement of the coronary arteries, especially in patients without treatment. It is estimated that coronary artery aneurysms occur in 15% to 25% of untreated children. Patients with coronary aneurysms [...] Read more.
Background: Kawasaki Disease (KD) is self-limited vasculitis, the main consequence of which may be involvement of the coronary arteries, especially in patients without treatment. It is estimated that coronary artery aneurysms occur in 15% to 25% of untreated children. Patients with coronary aneurysms may remain asymptomatic for years. The first symptom may be life-threatening sudden cardiac arrest or myocardial ischaemia. Methods: We report a case of a 17-year-old boy with an insignificant past medical history who presented with sudden cardiac arrest. Results: During diagnostics, channelopathies, structural heart defects, drug abuse, and myocardial infarction were excluded. The patient underwent coronary angiography, confirmed by CT angiogram of the coronary vessels, which revealed most likely ruptured, clotted, well-calcified aneurysm of the left anterior descending artery (LAD) with collateral circulation, probably a consequence of untreated Kawasaki disease in early childhood. Conclusions: Complications of KD should be considered in the differential diagnosis of sudden cardiac arrest, especially in a young person. Full article
(This article belongs to the Special Issue Further Advances in Electrocardiography, Cardiac Arrhythmias, and Arrhythmogenic Disorders)
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13 pages, 2940 KiB  
Project Report
Correlation between Epsilon Wave and Late Potentials in Arrhythmogenic Right Ventricular Cardiomyopathy—Do Late Potentials Define the Epsilon Wave?
by Urszula Skrzypczyńska-Banasik, Olgierd Woźniak, Ilona Kowalik, Aneta Fronczak-Jakubczyk, Karolina Borowiec, Piotr Hoffman and Elżbieta Katarzyna Biernacka
J. Clin. Med. 2024, 13(17), 5038; https://doi.org/10.3390/jcm13175038 - 25 Aug 2024
Viewed by 1284
Abstract
Introduction: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic disorder characterised by progressive fibrosis predominantly of the right ventricular (RV) myocardium, resulting in life-threatening arrhythmias and heart failure. The diagnosis is challenging due to a wide spectrum of clinical symptoms. The important [...] Read more.
Introduction: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic disorder characterised by progressive fibrosis predominantly of the right ventricular (RV) myocardium, resulting in life-threatening arrhythmias and heart failure. The diagnosis is challenging due to a wide spectrum of clinical symptoms. The important role of ECG was covered in the current diagnostic criteria. The role of the epsilon wave (EW) is still under discussion. Aim: The aim of the study was to examine a potential association between the EW and late ventricular potentials (LPs) in ARVC patients (pts). The correlation between RV dilatation or dysfunction and LPs/EW was also analysed. Methods: The ARVC group consisted of 81 pts (53 men, aged 20–78 years) fulfilling 2010 International Task Force Criteria. 12-lead ECG, LPs, Holter, and ECHO were performed in all pts. The presence of EW was analysed in ECG by 3 investigators. LPs were detected by signal-averaged ECG (SAECG). SAECG was considered positive for LPs when at least two of the three following criteria were met: (1) the filtered QRS duration (fQRS) ≥ 114 msec; (2) the duration of the final QRS fragment in which low-amplitude signals lower than 40 μV are recorded (LAS-40 > 38 msec); and (3) the root mean square amplitude of the last 40 milliseconds of the fQRS complex (RMS-40 < 20 μV). The results were compared with a reference group consisting of 53 patients with RV damage in the course of atrial septum defect (ASD) or Ebstein’s Anomaly (EA). Results: In the ARVC group, a significant relationship was observed between the occurrence of EW and the presence of LPs. EW was more common in the LP+ than in the LP- patients (48.1% vs. 6.9%, p < 0001; OR 12.5; 95% CI [2.691–58.063]). In ARVC pts, RVOT > 36 mm, RVIT > 41 mm, and RV S’ < 9 cm/s were observed significantly more often in the LPs+ than in the LPs− group (OR [95% CI]: 8.3 [2.9–1.5], 6.4 [2.2–19.0] and 3.6 [1.1–12.2], respectively). In the ARVC group, any of fQRS > 114 ms, LAS > 38 ms, and RMS < 20 μV were significantly more frequent in EW+ pts. In multivariate analysis, the independent factors of the EW were LAS-40 and RV S’. In the LPs− subgroup, RVOT > 36 mm was more frequent in ASD/EA than in ARVC (70.4% vs. 25%, p = 0.002). Similarly, in the LPs− subgroup, RVIT > 41 mm was encountered more frequently in ASD/EA than in ARVC (85.2% vs. 48.3%, p = 0.004). Conclusions: In ARVC, there is an association between EW and LPs, with both probably resulting from the same process of fibrofatty substitution of the RV myocardium. Although RV dilatation is common in ASD and EA, it does not correlate with LPs. Full article
(This article belongs to the Special Issue Further Advances in Electrocardiography, Cardiac Arrhythmias, and Arrhythmogenic Disorders)
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8 pages, 1206 KiB  
Case Report
Left Bundle Branch Area Pacing to Overcome Coronary Sinus Anatomy-Related Technical Problems Encountered during Implantation of Biventricular CRT—A Case Report
by Jędrzej Michalik, Roman Moroz, Marek Szołkiewicz, Alicja Dąbrowska-Kugacka and Ludmiła Daniłowicz-Szymanowicz
J. Clin. Med. 2024, 13(11), 3307; https://doi.org/10.3390/jcm13113307 - 4 Jun 2024
Viewed by 1094
Abstract
The results of clinical trials show that up to one-third of patients who are eligible for cardiac resynchronization therapy (CRT) do not benefit from biventricular pacing. The reasons vary, including technical problems related to left ventricle pacing lead placement in the appropriate branch [...] Read more.
The results of clinical trials show that up to one-third of patients who are eligible for cardiac resynchronization therapy (CRT) do not benefit from biventricular pacing. The reasons vary, including technical problems related to left ventricle pacing lead placement in the appropriate branch of the coronary sinus. Herein, we present a case report of a patient with heart failure with reduced ejection fraction and left bundle branch block, in whom a poor coronary sinus bed made implantation of classic biventricular CRT impossible, but in whom, alternatively, rescue-performed left bundle branch area pacing allowed effective electrical and mechanical cardiac resynchronization. The report confirms that left bundle branch area pacing may be a rational alternative in such cases. Full article
(This article belongs to the Special Issue Further Advances in Electrocardiography, Cardiac Arrhythmias, and Arrhythmogenic Disorders)
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