TY - JOUR T1 - Left ventricular electrical remodelling: a review. AU - Bacharova,Ljuba, AU - Varma,Niraj, AU - Schocken,Douglas D, AU - Felicioni,Sandro Pinelli, AU - de Alencar,José Nunes, Y1 - 2026/06/25/ PY - 2026/04/01/received PY - 2026/06/06/accepted PY - 2026/6/26/medline PY - 2026/6/26/pubmed PY - 2026/6/25/entrez KW - Electrocardiography KW - MYOCARDIAL FIBROSIS KW - RISK STRATIFICATION JF - Heart (British Cardiac Society) JO - Heart N2 - 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. SN - 1468-201X UR - https://www.unboundmedicine.com/prime/citation/42349937/Left_ventricular_electrical_remodelling:_a_review. DB - PRIME DP - Unbound Medicine ER -