Dr Galen Strohm Wagner, who was the editor-in-chief of the Journal of Electrocardiology since 2005, passed away on Jul 13, 2016. Wagner has an outstanding role as a mentor for young investigators in ...the beginning of their scientific careers. He considered critical discussions between scientists essential, and therefore cherished the peer-review process. He encouraged young scientists not only to conceive papers and submit them for peer review, but also encouraged them to serve as reviewers rather early in theft careers. Here, Pahlm et al offer an overview of Wagner's peer-reviewed scientific publications, mostly within cardiology in a broad sense, and covering about 60 percent of his 397 peer-reviewed original scientific articles.
An obituary for Galen S. Wagner, the editor-in-chief of the Journal of Electrocardiology who died on Jul 13, 2016, is presented. Being active as the director of the Cardiac Care Unit of the Duke ...University Medical Center from 1968 to 1981, Wagner was instrumental in the development of the world renowned Duke Cardiovascular Databank. He also helped establish the International Research Interdisciplinary School that offers outcome-research training programs in countries throughout the world that has been ongoing for the past eleven years.
Postoperative junctional ectopic tachycardia is a potentially life-threatening arrhythmia that is often resistant to conventional antiarrhythmic drugs. Amiodarone was suggested to be an adequate ...treatment; however, data regarding its efficacy and safety are limited. This study evaluated the efficacy of amiodarone in the first-line treatment of postoperative junctional ectopic tachycardia and assessed factors associated with failure of amiodarone therapy.
The study included 40 pediatric cardiosurgical patients with postoperative junctional ectopic tachycardia. Intravenous amiodarone in 2-mg/kg boluses and, if necessary, as continuous infusion (10 to 15 mug/kg/min), were used as the first-line therapy. Restoration of sinus rhythm or slowing of junctional ectopic tachycardia to a rate that allowed atrial or atrioventricular sequential pacing was considered as efficacy of therapy.
Amiodarone was effective in 18 patients (45%). Sinus rhythm was achieved in 7, and heart rate decreased in 11 patients from 180 (range, 173 to 200) to 142 (range, 133-155) beats/min (p < 0.0001) and allowed effective pacing with atrioventricular synchrony. Higher arteriovenous oxygen saturation difference (p = 0.007) and lower body temperature (p = 0.02) were associated with failure of amiodarone therapy.
Amiodarone as the first-line treatment was effective in almost half of the patients with postoperative junctional ectopic tachycardia. Higher arteriovenous oxygen saturation difference and lower body temperature were associated with failure of amiodarone therapy, and their presence may suggest more aggressive initial approach consisting of amiodarone combined with hypothermia.
Abstract The International Research Interdisciplinary School (IRIS) provides an interdisciplinary international environment for training skills required for preparing research study protocols, ...scientific manuscript and international collaboration. It is a common initiative of the Journal of Electrocardiology, Anatolian Journal of Cardiology, Monitor of Medicine of the Slovak Medical Society, Balkan Medical Journal, Central Asian Medical Journal, and Journal of Kyrgyz State Medical Academy, Cardiovascular Systems. In the period from 2006 to 2016, nineteen IRIS courses were organized in twelve countries on three continents (Austria, Brazil, Croatia, Kazakhstan, Kyrgyzstan, Macedonia, Poland, Romania, Russia, Slovakia, Spain, Turkey). Total number of participants is 315, from 33 countries (Albania, Austria, Bosnia and Herzegovina, Brazil, China, Colombia, Croatia, Czech Republic, Denmark, Egypt, Estonia, Georgia, Greece, Hong Kong, Hungary, Kazakhstan, Kosovo, Kyrgyzstan, Lithuania, Macedonia, The Netherlands, Poland, Portugal, Romania, Russia, Serbia and Montenegro, Slovakia, Spain, Sweden, Turkey, Ukraine, USA, Venezuela). The evaluation of the scientific performance of trainees for the period 2007–2013 showed that the IRIS training was associated with identifiable increase in scientific publication activity. The Journals benefited from the increased quality of submitted manuscripts and an increased pool of peer-reviewers.
Abstract Anatomical location of the conduction system may influence the characteristics of the depolarization and thus characteristics of the QRS complex. It is known that in the heart, there are ...electro-anatomical relationships, such as relationships among the molecular, genetic and anatomic components of the conduction system and papillary muscles. This review aims to discuss how knowledge of the electro-anatomical developmental relationships helps in understanding the known variability to be observed in the human electrocardiograms.
Abstract Background Cardiac magnetic resonance (CMR) is currently considered the reference standard for in vivo assessment of myocardial infarction (MI). There is, however, no international consensus ...on how MI quantification from CMR should be performed. The aim of this study was to test how previously published manual quantification of MI using CMR images compares with MI quantification using a semiautomated, validated method and how this impacts the relationship with MI size estimated by 12-lead electrocardiogram (ECG). Methods Twenty-five patients, from a previously published cohort, were included in the study. All patients had presented with clinical signs of acute coronary syndrome 6 to 12 months before undergoing a CMR examination. The patients had a standard 12-lead ECG recorded at the time of the CMR examination. The previously reported manually quantified MI size was compared with MI size determined using a semiautomated method validated by computer phantom data, experimental in vivo and ex vivo data, and patient data. The MI sizes from the 2 CMR approaches were then compared with the ECG-estimated MI size. Results There was a strong correlation between MI size determined with the 2 CMR methods ( r2 = 0.94, P < .001). There was, however, a systematic overestimation of MI size of approximately 50% by the previously published manually quantified MI size compared with the semiautomated method. This affected the comparison with estimated MI size by ECG, which showed a significant underestimation of MI size compared with manual CMR measurements, but no bias compared with the semiautomated CMR method. Conclusions Manual quantification of MI size by CMR can differ significantly from semiautomated, validated methods taking partial volume effects into account and can lead to erroneous conclusions when compared with ECG.
Abstract Background Systems providing computer-based analysis of the resting electrocardiogram (ECG) seek to improve the quality of health care by providing accurate and timely automatic diagnosis ...of, for example, cardiac rhythm to clinicians. The accuracy of these diagnoses, however, remains questionable. Objectives We tested the hypothesis that ( a ) 2 independent automated ECG systems have better accuracy in rhythm diagnosis than nonexpert clinicians and ( b ) both systems provide correct diagnostic suggestions in a large percentage of cases where the diagnosis of nonexpert clinicians is incorrect. Methods Five hundred ECGs were manually analyzed by 2 senior experts, 3 nonexpert clinicians, and automatically by 2 automated systems. The accuracy of the nonexpert rhythm statements was compared with the accuracy of each system statement. The proportion of rhythm statements when the clinician's diagnoses were incorrect and the systems instead provided correct diagnosis was assessed. Results A total of 420 sinus rhythms and 156 rhythm disturbances were recognized by expert reading. Significance of the difference in accuracy between nonexperts and systems was P = .45 for system A and P = .11 for system B. The percentage of correct automated diagnoses in cases when the clinician was incorrect was 28% ± 10% for system A and 25% ± 11% for system B ( P = .09). Conclusion The rhythm diagnoses of automated systems did not reach better average accuracy than those of nonexpert readings. The computer diagnosis of rhythm can be incorrect in cases where the clinicians fail in reaching the correct ECG diagnosis.
Objectives The objective of this study was to test the hypothesis that patients with primum atrioventricular septal defect (AVSD) have an imbalance in the positions of the left ventricular papillary ...muscles compared with healthy subjects, and that this anatomic imbalance correlates with left deviation of the QRS axis. Background The function and contraction pattern of the heart is best predicted when cardiac anatomy is considered together with its electrical activation sequence. Understanding the electroanatomic relationships is essential for discovering the developmental relationships between the conduction system and heart structures. Left deviation of the QRS axis is typically present in patients with primum AVSD. However, the pathophysiology of this phenomenon is not understood. Methods Thirty-five patients with primum AVSD and 35 healthy subjects were included in the study. Echocardiographic images were used to determine the papillary muscle positions. A 12-lead electrocardiogram was used to determine the QRS axis in the frontal plane in both patients and healthy subjects. Results An imbalance between papillary muscle positions in primum AVSD patients was defined as the position of the anterior papillary muscle closer to the septum and/or the position of the posterior papillary muscle further from the septum compared with the position of the papillary muscles in healthy subjects. In primum AVSD patients compared with control subjects, there was significant imbalance in the positions of the papillary muscles (p = 0.0007). The imbalance of papillary muscles correlated with deviation of the QRS (r = 0.5, p = 0.0019). Conclusions Abnormality in the position of the papillary muscles changes continuously with the abnormality of the QRS axis. Understanding the electroanatomic relationships provides important insight into developmental relationships between the conduction system and the trabecular structures in primum AVSD patients. These results may provide insights in understanding the continuity of primum AVSD abnormality, in estimating the best surgical approach, and predicting the prognosis of primum AVSD patients.
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