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September 28, 2026Annals of Noninvasive ElectrocardiologyOpen Access

The “Spiked Helmet Sign” on Electrocardiogram Following Left Ventricular Assist Device Implantation: A Case Report

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Key result

Spiked Helmet Sign on post-LVAD ECG heralds a localized pericardial hematoma successfully managed conservatively.

  • n=1

Why the study?

The ECG Spiked Helmet Sign after LVAD implantation may indicate localized pericardial hematoma and impending tamponade, requiring prompt recognition.

Population

1 68-year-old male with end-stage ischemic cardiomyopathy undergoing LVAD placement

Design

Case report

Follow-up

Hours postoperatively

Authors

QQQin QianLYLing YinSouthwest Medical University

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Implication

May signal post-LVAD pericardial hematoma; hypothesis-generating for the spiked helmet sign beyond pericarditis and needs prospective validation.

Key Points

  • To describe the clinical significance and diagnostic implications of the electrocardiographic 'spiked helmet sign' in detecting pericardial complications after left ventricular assist device implantation.
  • Clinical and diagnostic evaluation of a 68-year-old male with end-stage ischemic cardiomyopathy who underwent LVAD placement.
  • Postoperative monitoring included serial 12-lead electrocardiography, serum troponin I assays, and bedside transthoracic echocardiography.
  • Electrocardiogram hours post-surgery demonstrated the spiked helmet sign alongside marked QTc interval prolongation of 578 ms.
  • Bedside echocardiography revealed a 6-mm localized pericardial/mediastinal hematoma with transient troponin I elevation that resolved under conservative management.

Study Design

Type

Case Report (n=1)

Structured PICO

P
Population
A 68-year-old male with end-stage ischemic cardiomyopathy who developed the 'Spiked Helmet Sign' on ECG following LVAD implantation.
E
Exposure
Electrocardiogram monitoring post-LVAD implantation.
O
Outcome
Detection of pericardial complications (localized pericardial hematoma).surrogate

The 'Spiked Helmet Sign' on ECG after LVAD surgery is a critical indicator that should prompt immediate echocardiography to rule out pericardial hematoma and impending tamponade.

Cite This Study

Qian et al. (2026) conducted a case report in End-stage ischemic cardiomyopathy post-LVAD implantation (n=1). Spiked Helmet Sign on ECG was evaluated on Localized pericardial/mediastinal hematoma. The 'Spiked Helmet Sign' on ECG following LVAD implantation heralded a localized pericardial hematoma, which was successfully managed conservatively.

synapsesocial.com/papers/6ab9b62d7822ec8fc3d91daahttps://doi.org/10.1111/anec.70237

Topics

CardiomyopathyMechanical circulatory supportEchocardiography
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Helmet Sign on EKG: A Rare Indicator of Poor Prognosis in Critically Ill Patients2019 · 16 citations
  2. 2Spiked-helmet Sign: A Rare but Alarming Sign on Electrocardiogram2024 · 1 citations
  3. 3Electrocardiographic semi-spiked helmet sign in critically Ill patients: A case series2023 · 3 citations
  4. 4Reassessing the spiked helmet sign: an electrocardiographic hallmark of acute LAD occlusion2025
  5. 5Characteristics of the Electrocardiogram in Patients with Continuous-Flow Left Ventricular Assist Devices2014 · 29 citations