{
  "abstract": "The traditional electrocardiographic diagnosis of left ventricular hypertrophy (LVH) rests on the Voltage Paradigm, which assumes a linear relationship between QRS amplitude and left ventricular mass. High-resolution cardiac imaging has exposed fundamental anomalies in this framework: most patients with anatomic LVH have normal QRS amplitudes, while many with high amplitudes have normal mass. These discrepancies arise from non-spatial determinants—conduction velocity, fibrosis, cell-to-cell coupling and thoracic conductivity—that the linear model cannot accommodate. We propose replacing the term ‘ECG-LVH’ with Left Ventricular Electrical Remodeling (LVER), a framework endorsed by the International Society of Electrocardiology and the International Society for Holter and Noninvasive Electrocardiology encompassing four phenotypes: high QRS amplitude, conduction delay, low QRS amplitudes and QRS fragmentation. Each phenotype reflects a specific electrophysiological substrate carrying prognostic information independent of mass. LVER reframes the clinical task as electrical risk phenotyping.",
  "authors": [
    {
      "affiliations": [
        "Premedix, Bratislava, Slovakia"
      ],
      "name": "Ljuba Bacharova"
    },
    {
      "affiliations": [
        "Cleveland Clinic, Cleveland, Ohio, USA"
      ],
      "name": "Niraj Varma"
    },
    {
      "affiliations": [
        "Duke University, Durham, North Carolina, USA"
      ],
      "name": "Douglas D Schocken"
    },
    {
      "affiliations": [
        "Cardiology, Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil"
      ],
      "name": "Sandro Pinelli Felicioni"
    },
    {
      "affiliations": [
        "Cardiology, Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil"
      ],
      "name": "José Nunes de Alencar"
    }
  ],
  "title": "Left ventricular electrical remodelling: a review",
  "uid": "689934f1-7d3d-5bbb-9cb1-2ac87e60d176"
}