Background: Internal medicine specialists have always been one of the pillars that support the health of Indonesian people. Currently, there is no available survey regarding the socio-demography, lifestyle, and income of any medical specialist in Indonesia. This study aims to report this gap in knowledge amongst internists across Indonesia. Methods: This study was a nationwide cross-sectional study and was conducted via online questionnaires by The Indonesian Society of Internal Medicine Specialists (INASIM) between December 2023 and March 2024. Participants from the existing 39 INASIM branches were selected using cluster random sampling, with a target of 20% of registered internists per branch. Of 1,568 internists invited, 1,082 (69.0%) completed the questionnaire and were included. Results: A total of 1,082 internists participated in this study, mostly male (57.7%), aged 35-49 years (57.7%), non-academic staff (64.3%), practicing as general internists (76.3%) in 3 locations (70.9%). Distribution discrepancy was observed with 58.0% of general internists and 71.5% of subspecialists practicing in urban areas only. Income analyses showed significant positive correlations with age, working years, working hours, and number of practices. Male internists had higher income than their counterparts, indicating a gender-related income gap. The location of practice did not affect income significantly. Amongst internists, there were approximately 11.1% with a history of smoking, 55.9% with daily coffee consumption, 62.9% with sleep deprivation, and more time spent being sedentary. Conclusion: This study identified distribution discrepancy, a gender-related income gap, and unhealthy lifestyle patterns among Indonesian internists, which are issues that warrant targeted policy responses. Nevertheless, these findings may support future policies on equitable workforce distribution, appropriate incentive systems, and physician wellness programs in Indonesia.

Background: Cardiovascular (CV) disease remains the leading cause of mortality and disability worldwide, particularly in developing countries. Beyond mortality, health-related quality of life (HRQoL) is increasingly recognized as a key outcome and is commonly assessed using patient-reported measures. In Indonesia, cultural and linguistic diversity poses challenges, as most HRQoL instruments have been developed in other contexts. This scoping review aimed to map HRQoL research in Indonesian cardiovascular disease populations by identifying validated instruments, describing study designs and measurement tools, and summarizing HRQoL outcomes. Methods: This review was registered on Figshare (DOI: 10.6084/m9.figshare.29218991) and conducted following the Joanna Briggs Institute methodology and PRISMA-ScR guidelines. Literature searches were performed in PubMed, ScienceDirect, Google Scholar, and included grey literature. Studies reporting HRQoL measurement in Indonesian populations were included. Results: A total of 54 studies were included. Both generic and disease-specific HRQoL instruments were identified. Common generic tools included SF-36, SF-12, WHOQOL-BREF, and PedsQL, while disease-specific instruments included MLHFQ, KCCQ, Seattle Angina Questionnaire, AFSS, ASTA, AFEQT, MacNew, and AQUAREL. Only several instruments have been culturally validated, while others were used without prior validation, and some validated tools remained underutilized. HRQoL was influenced by clinical, psychological, behavioral, and social factors. Conclusion: HRQoL research in Indonesia is growing but remains heterogeneous. This mismatch highlights a critical gap between research capacity and real-world implementation in Indonesia. Greater use of standardized tools and longitudinal designs is needed to strengthen patient-centered cardiovascular care.

Background Cardiovascular and cerebrovascular diseases are the top global causes of mortality. Internal medicine professionals are vital in educating the public on prevention, yet they themselves may experience the very risk factors they warn against. Objectives This study aimed to assess cardiometabolic risk factors among Indonesian internal medicine specialists to raise awareness among health care workers. Methods This cross-sectional study was conducted by the Indonesian Society of Internal Medicine (INASIM). Our study recruited 1,568 internal medicine specialists from 39 INASIM branches in Indonesia using clustered random sampling (December 2023-March 2024). Cardiometabolic risk was calculated using atherosclerotic cardiovascular disease (ASCVD) risk scores and SCORE-2 (Systematic Coronary Risk Evaluation-2) Asia Pacific. Results The mean age of 1,064 participants who completed the study was 45 ± 10.4 years. The prevalences of dyslipidemia, obesity, hypertension, and diabetes mellitus were 84.6% (95% CI: 82.4%-86.9%), 61.4% (95% CI: 58.5%-64.3%), 20.3% (95% CI: 17.9%-22.7%), and 10.2% (95% CI: 8.4%-12.1%), respectively. Participants’ 10-year ASCVD risk scores were 6.0% (95% CI: 4.4%-8.1%) high, 18.5% (95% CI: 15.7%-21.7%) intermediate, 9.6% (95% CI: 7.5%-12.1%) borderline, and 66.0% (95% CI: 62.2%-69.6%) low. Their SCORE-2 Asia Pacific risk scores were 1.2% (95% CI: 0.5%-2.5%) very very high, 10.7% (95% CI: 8.3%-13.7%) very high, 46.5% (95% CI: 42.1%-50.9%) high, and 41.6% (95% CI: 37.3%-46.1%) moderate. Conclusions The prevalences of dyslipidemia and obesity were high among internal medicine specialists in Indonesia. The prevalences of highest risk category profile were 6.0% (ASCVD) and 1.2% (SCORE-2).

Tricuspid Regurgitation (TR) surgical treatment is associated to high operative mortality, suboptimal long-term survival, and frequent TR recurrence after repair, especially in the elderly. This case report highlights our early experience of TricValve implantation in Indonesia, conducted on a 72-year-old male patient with severe tricuspid regurgitation and advanced right ventricular dysfunction. In this context, the TricValve system offers a promising, less invasive alternative. Despite previous pharmacological management, our patient had been readmitted multiple times due to refractory right heart failure. One month post-TricValve implantation, he showed significant symptomatic relief and stable cardiac function as evidenced by echocardiographic measurements. This case underscores the potential utility of the TricValve system in providing an effective, lower-risk treatment option for patients not suited for traditional surgical intervention.

BackgroundObesity constitutes a significant global health concern, including in Indonesia, through increased risk of non-communicable diseases. Physicians, as healthcare providers, are not exempt from the impact of obesity toward general health, quality of life, and work performance. Among physicians, internists are particularly significant, as they assume primary responsibility for the management of obesity, thus the primary focus in this study. Obesity in internists is related to modifiable and non-modifiable risk factors. Therefore, identification of prevalence and risk factors of obesity in internists may aid in the improvement of their health through risk factor modification.MethodsA multicenter randomized cross-sectional study with a total sample of 1,064 internists across Indonesia is conducted to identify obesity profile and risk factors. Data were collected through questionnaire, physical examination, and biochemical testing and were analyzed using descriptive, bivariate, and multivariate analyses.ResultsThe prevalence of obesity in Indonesian internists is 61.4%, higher than the general population. Risk factors associated with obesity in Indonesian internists after adjusting for confounding factors were male gender (aOR 1.43, 95% CI 1.08-1.90), hypertension (aOR 1.88, 95% CI 1.26-2.79), history of diabetes mellitus (aOR 2.93, 95% CI 1.53-5.60), newly diagnosed diabetes mellitus (aOR 2.41, 95% CI 1.22-4.77), newly diagnosed prediabetes (aOR 1.70, 95% CI 1.26-2.30), and inadequate physical activity (aOR 1.85, 95% 1.15-2.98).ConclusionInternists are a special population differing in prevalence of obesity and its related risk factors compared with the general population, due to high professional demand impacting healthy lifestyle and behavior.

BackgroundPredicting premature ventricular contraction (PVC) origin pre-ablation is a fundamental step, as right ventricular outflow tract (RVOT) PVC often leads to higher success rates.ObjectiveTo compare nine published ECG criteria to differentiate between RVOT and non-RVOT origins of PVCs and develop a stepwise algorithm using those criteria to better determine PVC origin to predict ablation success.MethodsTwo centers were involved in this study, the derivation group and the validation group. The derivation group included 65 patients with PVC left bundle branch block (LBBB) pattern morphology (predominantly negative in lead V1) and inferior axis (predominantly positive in leads II and III), who underwent ablation at Cipto Mangunkusumo Hospital (RSCM) (2017-2022). The validation group included 291 patients who underwent ablation at the Taipei Veteran General Hospital (2020-2023). We calculated and compared six diagnostic accuracy measures from nine previously published ECG morphology criteria to develop an algorithm to enhance the accuracy of predicting RVOT PVC origin for successful ablation.ResultsOur multistep algorithm using Criteria 5, 8, and 1 enhanced diagnostic performance compared to using each criterion alone. The accuracy, sensitivity, and specificity in the derivation group were 86.2%, 93.6%, and 66.7%, respectively; those in the validation group were 85.9%, 90.8%, and 64.7%, respectively. The ROC curve AUCs were 0.802 and 0.775, respectively.ConclusionIn cases of inferior axis and LBBB pattern PVCs, a multistep algorithm using multiple criteria increases the accuracy of predicting RVOT PVC origin instead of using a single criterion.

Cardiac tamponade is a rare but fatal complication of catheter ablation. We are reporting a case of a 73-year-old male with ventricular tachycardia (VT) storm undergoing urgent VT ablation, who was later found to have right ventricle (RV) perforation—an unusual site for catheter ablation complication. The patient underwent isochronal late activation mapping (ILAM)-based ablation and elimination of local abnormal ventricular activities (LAVA). After procedure, his blood pressure rapidly decreased, and he was found to have cardiac tamponade. The tamponade was recurring despite of pericardial pigtail placement; thus, the patient was prepared for open-heart surgery. To preserve blood, auto transfusion was used as a bridging therapy.

Background: Understanding quality of life status (QoL) is essential to know patient’s well being after pacemaker implantation. Most of the pacemaker’s recipients are elderly. Elderly patients have been associated with multiple comorbities that may interact one another with frailty is the major comorbid in elderly patients. However, there is not much known about the relationships of frailty and its associate factors towards patient’s quality of life status in pacemaker population. Aim: To analyze the association of frailty status and other factors such as age, gender, BMI, hypertension, diabetes, LVEF to QoL in bradyarrhythmic patients post permanent pacemaker implantation. Methods: This is a cross-sectional study in cardiovascular outpatient department at Cardiocerebrovascular Integrated Unit in Cipto Mangunkusumo Hospital, Jakarta. Frailty status was assessed with FI-40 score and quality of life was assessed with AQUAREL questionnaire. Data analysis was conducted with bivariate analysis and logistic regression to assess the interaction of risk factors to the quality of life. Results: There were 135 subjects, 68 (50.4%) people were men, aged 69 (64-78) years old, 64 (47.4%) people was a retiree, with 55 (40.9%) people had high school as education background. There were 101 (74.8%) people with a history of dual chamber permanent pacemaker implantation, with TAVB (40.7%) and SND (30.4%) as the most common etiology. The median duration of permanent pacemaker implantation was 4 (2-5.5) years. After adjusting for confounding factors such as age, sex, LVEF, BMI, frailty status was associated with all domain in AQUAREL questionnaire [8.934 (95%CI: 2.66-30.02) for dyspnea domain, 21.56 (95%CI: 5.09-91.33) for chest dyscomfort domain, and 19.78 (95%CI: 4.93-79.43) for arryhthmia domain]. Conclusion: Frailty status was associated with quality of life in elderly bradyarrhythmic patients post permanent pacemaker implantation in Cipto Mangunkusumo hospital.

Internists are at the forefront of providing care for COVID-19 patients. This situation adds more strain on already overburdened internists, particularly in Indonesia, where resources are scarce and unevenly distributed. The pandemic altered working conditions due to restrictions and regulatory changes. Multiple evidence exists for the effect of the COVID-19 pandemic on physicians’ well-being, but less is known about its impact on their work dynamics and livelihoods. This study provides some lessons learned during the COVID-19 pandemic regarding the changes in working conditions and earnings experienced by Indonesian internists. There were 3,115 and 1,772 participants in the first and second survey, respectively. After one year, the proportion of internists handling COVID-19 cases, including critical COVID-19 cases, increased; with fewer internists over 60 years old involved. Working hours, number of patients, and monthly earnings decreased for the majority of internists. The increased workload was experienced by most participants one year of the pandemic, predominantly reported by female internists. The COVID-19 pandemic caused a considerable impact on working conditions and income amongst internists in Indonesia. These findings may provide information to institutions in formulating strategies and tools to improve the working conditions and livelihoods of internists in Indonesia amidst the pandemic and potential public health emergencies in the future.

Cardiotoxicity associated with chemotherapy, also known as Cancer Therapy-Related Cardiac Dysfunction (CTRCD), affects 10% of patients undergoing chemotherapy and is the most undesirable side effect of chemotherapy. Over time, it is anticipated that there would be an increase in the number of cancer patients receiving treatments that could harm their cardiovascular systems. Physicians should choose whether to continue, halt, delay, or reduce the dose of chemotherapeutic drugs to reduce the impact of cardiotoxicity. Cardiotoxicity screening and diagnosis need a variety of methods, primarily echocardiography to evaluate Left Ventricular Ejection Fraction (LVEF) and Global Longitudinal Strain (GLS). Depending on the clinical state, these procedures may be carried out prior to, during, or following chemotherapy. It's critical to reduce cardiovascular risk factors and offer advice on leading a healthy lifestyle before giving cancer patients medicines. There are a lot of cancer treatment facilities all around the world that don't have evidence-based perspective cardiotoxicity scores to stratify the risk of cardiovascular problems caused by cancer therapy. Additionally, comorbid conditions like diabetes and hypertension are frequently present in cancer patients, which can have a significant impact on clinical outcomes and cancer treatment. Therefore, this article aims to discuss assessment methods, clinical practice guidance, and prevention of CTRCD.

BACKGROUND:The Arrhythmia-Specific Questionnaire in Tachycardia and Arrhythmia (ASTA) was developed in Sweden using English which may pose cultural and language barriers for Indonesian patients. As such, we aimed to translate the original ASTA into Indonesian, then assess its validity and reliability.METHODS:Translation of the ASTA from English to Indonesian was done using forward and backward translation. The final version was then validated with the Short Form-36 (SF-36) questionnaire. Test-retest reliability study was done in a 7-14-day interval.RESULTS:The Indonesian version of ASTA was deemed acceptable by a panel of researchers with Cronbach's α of 0.816 and Intraclass Correlation Coefficient (ICC) ranging from 0.856-0.983. In a comparison to the SF-36, the medication utilization domain was poorly correlated with role limitations due to physical health (r:0.384; p<0.01) and pain (r:-0.317; p<0.05). The arrhythmia-specific symptoms domain was poorly correlated with role limitations due to emotional problems (r:0.271; p<0.05). In addition, the health-related quality of life (HRQOL) domain was poorly correlated with role limitations due to physical health (r:0.359; p<0.01) and emotional problems (r:0.348; p<0.01), also total SF-36 score (r:-0.367; p<0.01). The ASTA total score was poorly correlated with role limitations due to physical health (r:0.37; p<0.01), and emotional problems (r:0.376; p<0.01), also total SF-36 score (r:-0.331; p<0.01).CONCLUSION:The Indonesian version of ASTA has good internal and external validity as well as good reliability. Both the physical and mental domains of ASTA are correlated with role limitations due to emotional problems and SF-36 total score.

Beta thalassemia major (TM) is a common hereditary disease in Indonesia. Iron overload due to regular transfusion may induce myocardial iron deposition leading to electrophysiological dysfunction and functional disorders of the heart. Ventricular arrhythmia is one of the most common causes of sudden cardiac death in thalassemia patients. This cross-sectional study of 62 TM patients aged 10-32 years in Cipto Mangunkusumo General Hospital was done to assess their electrophysiological properties and heart rate variability, including 24- hour Holter monitoring, signal averaged electrocardiogram (SAECG) for detection of ventricular late potential (VLP), and determination of heart rate variability (HRV). We also assessed their 12-lead ECG parameters, such as P wave, QRS complex, QT/ QTc interval, QRS dispersion, and QT/ QTc dispersion. Iron overload was defined by T2-star magnetic resonance (MR-T2*) values of less than 20 ms or ferritin level greater than 2500 ng/mL. Subjects were grouped accordingly. There were significant differences of QTc dispersion (p = 0.026) and deceleration capacity (p = 0.007) between MR-T2* groups. Multivariate analysis showed an inverse correlation between QTc dispersion and MR-T2* values. There was a proportional correlation between heart rate deceleration capacity in the low MR-T2* group (p = 0.058) and the high ferritin group (p = 0.007). No VLPs were detectable in any patients. In conclusion, prolonged QTc dispersion and decreased heart rate deceleration capacity were significantly correlated with greater odds of iron overload among patients with Thalassemia major.

In the atrial fibrillation (AF) population, worsened quality of life (QOL) has been reported even before complications occur. Symptom-based questionnaires can be used to evaluate AF treatment. The Atrial Fibrillation Severity Scale (AFSS) was first developed in Canada in English, which is not the main language in Indonesia. This study aims to test the reliability and validity of the Indonesian version of the Atrial Fibrillation Severity Scale (AFSS). Translation of the AFSS from English to Indonesian was done using forward and backward translation. The final version was then validated with the Short Form-36 (SF-36) questionnaire, and a test-retest reliability study was done in a 7-14-day interval. An Indonesian version of AFSS was achieved and deemed acceptable by a panel of researchers. This version is reliable and valid, with Cronbach’s α of 0.819, Intraclass Correlation Coefficient (ICC) ranging from 0.803 to 0.975, and total score correlation ranging from 0.333 to 0.895. Pearson’s analysis of AFSS and SF-36 revealed that the total AF burden domain was poorly correlated with role limitations due to emotional problems (r:0.427; p < 0.01) and pain (r:0.495; p < 0.01). The symptom severity domain was poorly correlated with physical functioning (r:-0.335; p < 0.01), role limitations due to emotional problems (r:0.499; p < 0.01), pain (r:0.458; p < 0.01), and total SF-36 score (r:-0.361; p < 0.01). Total AFSS score was moderately correlated with role limitations due to emotional problems (r:0.516; p < 0.01) and pain (r:0.538; p < 0.01). The total AFSS score was poorly correlated with the European Heart Rhythm Association (EHRA) score (r:0.315; p < 0.01). The Indonesian version of AFSS has good internal and external validity with good reliability.

Background More than 60% of patients with atrial fibrillation (AF) have a significant health-related quality of life (HRQoL) impairment. HRQoL, a patient-reported outcome (PRO), has become an important endpoint to assess treatment success in AF patients. The Atrial Fibrillation Effect on Quality of Life (AFEQT) questionnaire is an AF-specific HRQoL tool shown to be feasible, reliable, and valid, with translations in various languages. Since this questionnaire has never been translated or validated in Indonesian, we aimed to determine the validity and reliability of the Indonesian version of the AFEQT questionnaire for AF patients. Results This cross-sectional, observational study was conducted in the Integrated Cardiovascular Service Polyclinic, Cipto Mangunkusumo Hospital, Indonesia, from December 2021 to March 2022. A total of 30 participants were recruited for cross-cultural adaptation process, which consisted of translation and adaptation process, and a total of 102 participants were consecutively recruited to participate in the validation process, which consisted of validity test (construct validity) and reliability tests (internal consistency and test-retest). The retest was conducted within a 1–2-week interval after the baseline assessment, by analyzing the intraclass correlation coefficient (ICC). The construct validity was determined by multitrait scaling analysis, and the convergent and divergent validity was compared to SF-36 domains. Multitrait scaling analysis revealed that all items in the Indonesian version of the AFEQT questionnaire had a strong negative correlation towards their respective domains (r -0.639–-0.960). For convergent and divergent validity, AFEQT domains had weak to strong positive correlations to all SF-36 domains (r 0.338–0.693). This questionnaire also had acceptable internal consistency (Cronbach’s α for overall score: 0.947; Domains: Symptoms: 0.818, Daily Activities: 0.943, Treatment Concern: 0.894, and Treatment Satisfaction: 0.865), as well as moderate-to-good test-retest reliability (0.521–0.828). Conclusions The Indonesian version of the AFEQT questionnaire has good validity and reliability for assessing quality of life of atrial fibrillation patients in Indonesia.

Introduction COVID -19 pandemic has threatened the optimal achievement on type-2 diabetes mellitus (T2DM) target in primary health care (PHC), due to our priority in COVID-19 management, limited access of patients to PHC and their lifestyle changes as the impact of social restrictions. Therefore, the empowerment of capability of patients on diabetes self-care is required through optimal education and support. The use of telehealth in T2DM management has benefits on improving outcomes of patients. We aim to assess the role of telehealth diabetes self-management education (DSME) versus hybrid (telehealth and face-to-face method) diabetes self-management education and support (DSMES) to improve T2DM outcomes in PHC during COVID-19 pandemic. Methods and analysis This study is an open label randomized-controlled trial that will be conducted in 10 PHCs in Jakarta, Indonesia, involving patients with T2DM. Subjects are classified into 2 groups: DSME group and DSMES group. Intervention will be given every 2 weeks. DSME group will receive 1 educational video every 2 weeks discussing topics about diabetes self-management, while DSMES group will receive 1 educational video and undergo 1 coaching session every 2 weeks. All interventions will be conducted by trained health workers of PHC, who are physicians, nurses, and nutritionists. Our primary outcome is the change of HbA1C level and our secondary outcomes are the changes of nutritional intake, physical activity, quality of life, anthropometric parameter, fasting blood glucose, lipid profile, inflammatory markers, and progression of diabetes complications at 3 and 6 months after intervention compare to the baseline. Ethics and dissemination This study protocol has been approved by the Health Research Ethics Committee University of Indonesia. Subjects agree to participate will be given written informed consent prior to data collection. Findings from this study will be published in peer-reviewed journals and presented at conferences. Trial Registration with identifier number [NCT05090488][1]. Strengths and limitations of the study ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial NCT05090488 ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics committee/IRB of Faculty of Medicine, University of Indonesia gave ethical approval for this work I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors * T2DM : type-2 diabetes mellitus PHC : primary health care OAD : oral anti-diabetic DSMES : diabetes self-management education and support SMBG : self-monitoring of blood glucose [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT05090488&atom=%2Fmedrxiv%2Fearly%2F2022%2F12%2F19%2F2022.12.18.22283494.atom

Background: The mortality rate of COVID-19 patients in Indonesia is high with manifestations of cardiac complications. Echocardiographic evaluation can help identify cardiac functional and structural disorders associated with patient mortality. Therefore, this study aims to determine the relationship between echocardiographic abnormalities and mortality in severe and critical COVID-19 patients. Methods: Data on severe and critical COVID-19 patients at Cipto Mangunkusumo General Hospital were taken based on medical records and then analyzed by displaying descriptive tables, while bivariate and multivariate analyses were carried out with chi-square and logistic regression respectively. Results: Among the total 83 patients, 48 ​​or 57.8% died, while the most common functional abnormality found on echocardiography was mPAP in 51 or 68%, and the most structural disturbance was left ventricular concentric remodeling in 48 or 58%. The chi-square analysis results of echocardiographic variables namely TAPSE with RR = 7.292, Right Ventricular Systolic Pressure (RVSP) 10.208, mean Pulmonary Artery Pressure (mPAP) 1.440, Pulmonary Acceleration Time (PAT) 2.357, and Right Atrial Pressure (RAP) 3.403 had a significant relationship with mortality. Meanwhile, LVEF, E/e' and CO have no significant relationship. Based on the multivariate analysis, variables independently associated with mortality were RVSP and RAP. Conclusion: Echocardiographic abnormalities associated with mortality in severe and critical COVID-19 patients are TAPSE, RVSP, mPAP, PAT and RAP estimation.

Sejak elektrokardiografi (EKG) dibawa ke perhatian klinisi oleh Einthoven sampai dengan saat ini, EKG masih merupakan modalitas yang tidak dapat dipisahkan dalam penilaian sistem kardiovaskular. Namun, pemeriksaan yang sederhana dan tidak invasif ini, tidak selalu mudah untuk diintepretasikan. Hasil yang tergambar di kertas EKG tidak murni dipengaruhi jaringan otot jantung saja, namun dipengaruhi juga oleh jaringan tubuh lain yang terdapat di antara jantung dan lokasi dimana elektroda diletakkan. Dengan demikian, hal ini juga harus dipertimbangkan dalam menginterpretasikan hasil EKG.

Introduction : Right bundle branch block (RBBB) is a condition when left ventricle is depolarized first before right ventricle. Two types of RBBB can be distinguished, anatomical and functional. In anatomical RBBB, the conduction to the right bundle is severed and cannot deliver any impulse propagation. Functional RBBB is due to longer refractory period. When impulse arrived with longer interval, it can propagates via the right bundle.

Introduction : Speckle tracking has been increasingly used to analyse LV function. With this modality, Global Longitudinal Strain (GLS) has emerged as a new sensitive diagnostic tool for evaluating early LV systolic dysfunction. The other advantage of speckle tracking can be used to evaluate LV desynchronization using Time To Peak (TTP). Electrocardiography, on the other hand, gave an electrical snapshot of the heart. Recently, SAECG had been shown to be able to predict very late potentials of ventricle that correspond to a slow conduction within the ventricle. However, these two methods need trained personals and specialized software.