ArticleJACC. Case reports2026
Double-QRS Complex Revealing a Multilayer Intramural-Epicardial Ventricular Tachycardia Circuit in Cardiac Sarcoidosis.
Article in JACC. Case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
1 citing paper in PubMed.
- Seeing Beyond the Surface: ECG Clues of Multilayer Arrhythmogenic Substrate.JACC. Case reports · 2026Article
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCardiac sarcoidosis can create multilayer intramural-epicardial conduction pathways that manifest as subtle electrocardiographic abnormalities during sinus rhythm. A second low-amplitude deflection following the QRS complex ("double-QRS") has been observed clinically, but its electrophysiological mechanism remains unclear. CASE SUMMARY: A 67-year-old man with cardiac sarcoidosis exhibited a sinus-rhythm double-QRS pattern that changed in timing and polarity after corticosteroid therapy and preceded sustained monomorphic ventricular tachycardia. High-density mapping identified 2 intramural-epicardial connections linking a broad intramural septal corridor to epicardial breakthrough sites at the anterior right ventricular outflow tract and inferior right ventricle. Entrainment confirmed a multilayer reentry circuit. Ablation targeting the intramural isthmus and epicardial exits modified the double-QRS timing, and definitive bipolar ablation eliminated all inducible ventricular tachycardia and abolished the double-QRS pattern. DISCUSSION: A sinus-rhythm double-QRS complex may reflect delayed epicardial activation through intramural-epicardial pathways. TAKE-HOME MESSAGE: Resolution of a double-QRS complex after ablation supports its role as a surface electrocardiographic marker of multilayer conduction.
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