The prevalence rate of cardiovascular diseases in China has been increasing, therefore the precise diagnosis and treatment of arrhythmias is particularly critical. ECG examination is the main basis for the diagnosis of arrhythmias. At present, artificial intelligence ECG analysis technology has brought new possibilities to improve the efficiency and accuracy of clinical diagnosis and treatment of arrhythmias. This paper reviews the latest progress in the application of artificial intelligence ECG analysis technology at home and abroad, and summarizes the prospects and challenges of the technology in the diagnosis of arrhythmias.

Atrial fibrillation(AF) is one of common arrhythmias in clinical practice. AF gives rise to a series of complications including stroke, thromboembolism and heart failure, which cause high disability rate and mortality, and increased family and social burdens. The treatment technology of AF is becoming more refined in modern medicine while traditional Chinese medicine has also achieved definite effect on AF. This paper reviews the research progress of diagnosing and treating AF with traditional Chinese medicine (TCM) from aspects of knowledge of disease name and pathogeny of AF in TCM, and typical TCM prescriptions, Chinese patent medicine and needle therapy of treating AF in TCM. This paper aims to provide new ideas for the diagnosis and treatment of AF.

Heart rate variability (HRV) is a non-invasive index for assessing the autonomic nervous system’s regulation of cardiac rhythm. This index reflects the automaticity of the heart and information related to physiological states. HRV has been used to evaluate the cardiac health, predict the risk of cardiovascular events, and monitor the efficacy of diseases. In recent years, related studies have found that HRV also has important values in evaluating non-cardiovascular system diseases, as well as mental stress and stress responses. This article reviews the history, recent advances in research and application of HRV, aiming to provide more information for clinical physicians.

Significant prolongation of QT interval would easily cause malignant arrhythmias, and therefore in the research and development of new drugs, great importance should be attached to the evaluation of QT interval prolongation. As a necessary guiding principle for new drug research and development, ICH-E14 Guidelines, in the form of industry norms, stipulates that new non-antiarrhythmic drugs must be evaluated for QT/QTc interval prolongation before marketing. It means that electrocardiogram (ECG) monitoring will play an important role in the safety evaluation of this kind of drugs. In order to complete the collection and comprehensive analysis of ECG data with high standards and quality, this paper focuses on the methodology of QT/QTc interval measurement from several aspects. It introduces the requirements for instruments and personnel during QT interval measurement, the selection of measurement leads, the determination of QT interval starting and end points,  QT interval measurement under different circumstances，different correction methods for QT intervals, and notes during data measurement.

The National Medical Products Administration demands that the relevant requirements for  drug clinical studies initiated since July 31, 2023 follow the “E14: the clinical evaluation of QT/QTc interval prolongation and proarrhythmic potential for non-antiarrhythmic drugs”. This paper introduces QT interval and QTc, non-antiarrhythmic drugs potentially leading to QT interval prolongation and even torsade de pointes, the mechanism of QT interval prolongation, predisposing factors, and other related issues. It is aimed to arouse more attention to the effects of new nonantiarrhythmic drugs on QT/QTc interval among clinicians, and to improve the safety of drug use.

Objective To analyze initial and reexaminations of ECGs among enlisted male youths excluding functional changes due to various adverse influencing factors so as to prevent adverse cardiac events after enlistment and ensure the selection of physically and psychologically qualified candidates for the military. Methods Retrospective analysis was performed in the ECG examination results of 2 065 enlisted male youths. The age range of the examines was 18 to 22 years with a mean of (20.0±1.5) years. According to ECG diagnostic criteria, ECG changes of initial and reexaminations were analyzed. ResultsAmong the 2 065 enlisted male youths, abnormal ECGs were detected in 330 cases: sinus tachycardia in 30 cases (including 13 cases with concurrent ST-T changes), sinus bradycardia in 11 cases, premature beats in 19 cases, STT changes in 60 cases, early repolarization with elevated J point in 80 cases, right ventricular dominance in 12 cases, short PR interval in 56 cases, significant axis deviation in 10 cases, firstdegree atrioventricular block in 25 cases, seconddegree atrioventricular block in 1 case, left anterior fascicular block in 6 cases, atrial rhythm and atrial escape rhythm in 2 cases each, complete right bundle branch block in 12 cases, atrial fibrillation in 1 case, and ventricular preexcitation in 3 cases. A week later, reexamination was performed in the 330 cases with abnormal ECGs out of whom 277 cases turned to be normal, including sinus tachycardia (including 11 cases with concurrent ST-T changes) in 28 cases (93.33%), sinus bradycardia in 11 cases (100%), premature beats in 17 cases (89.47%), ST-T changes in 56 cases (93.33%), early repolarization with elevated J point in 68 cases (85.00%), right ventricular dominance in 11 cases (91.67%), short PR interval in 50 cases (89.29%), significant axis deviation in 8 cases (80.00%), firstdegree atrioventricular block in 22 cases(88.00%), left anterior fascicular block in 2 cases (33.33%), and atrial rhythm and atrial escape rhythm in 2 cases each (100%); the remaining cases were all unqualified in the reexamination. Except for seconddegree atrioventricular block, left anterior fascicular block, complete right bundle branch block, atrial fibrillation and ventricular preexcitation, there were statistically significant differences in the incidences of other ECG abnormalities between initial and reexaminations (all P<0.05). ConclusionBefore physical examinations of enlisted male youths, they should correct unhealthy living habits and keep a positive attitude in advance. ECG physicians should patiently recheck unqualified ECGs to exclude functional changes before confirming unqualified ECG results.

The etiology of sudden unexplained death (SUD) is complicated, and its  incidence remains significant at present. The key to its prevention and treatment lies in identifying the underlying pathogenic factors. With the progress of molecular biology techniques, numerous  studies at home and abroad have substantiated a strong association between sudden cardiac death (SCD) caused by pathogenic gene mutations and SUD. The conspicuous clustering characteristics observed in cases of Yunnan sudden unexplained death (YNSUD) indicate the potential involvement of molecular genetics. In the population of the affected area, the detection rates of abnormal electrocardiogram (ECG) indicators increased while cardiac pathological changes were found in 90% of sudden death cases, which further implies a possible correlation between YNSUD and pathogenic gene mutations related to SCD. Understanding the genetic predisposition, genetic mutation, risk factors, and pathogenic mechanisms of SCD contributes to identifying the highrisk factors associated with this kind of sudden death, so as to carry out targeted prevention and treatment. This paper reviews the current research trends in hereditary arrhythmias and hereditary cardiomyopathy related to SUD, and summarizes the latest research results and pathogenic factors.It is aimed to provide a foundation for further investigations on the etiology.

Leadless pacemakers (LPMs), which have emerged in recent years, avoid the lead and pocketrelated complications associated with conventional lead pacemakers, such as tricuspid regurgitation, lead fracture, lead endocarditis or pocket infection. Not only has LPM a significant advantage over conventional pacemakers in terms of safety, but also its stability of pacingrelated parameters has been demonstrated during a relatively long followup period.  At present, LPM has been approved for marketing in China. Although the application of LPM is still in its infancy, the implantation volume is growing rapidly, therefore its development prospect in the future is good. This article reviews  the clinical application evidences of existing LPM, related techniques and postoperative management of LPM implantation, future development direction of LPM, and so on.

More and more studies have shown that the risk of arrhythmias in diabetes patients is significantly increased, but their mechanisms are complex and have not been fully clarified at present. Based on explaining the relationship between  diabetes and arrhythmias, this article  reviews the mechanisms of diabetes related arrhythmias from aspects of inflammation, oxidative stress, autonomic nervous dysfunction, mitochondrial dysfunction, electrical remodeling, blood glucose levels, glucose fluctuations, etc. It is aimed at providing a novel strategy for the prevention and treatment of this disease.

 Objective  To establish the normal reference range of electrocardiogram (ECG) in healthy neonates with different sexes. Methods  We recorded and measured routine 12-lead synchronous ECGs of 906 healthy neonates (including 474 males and 432 females), and made statistical analysis of the collected data. We  obtained the normal  reference  ranges of the related ECG indexes  (including heart rate, mean QRS axis, P-wave duration, PR interval, P-wave amplitude, QRS duration, QRS amplitude, QTc, T-wave amplitude, etc.), and the morphologies of P-wave, QRS complex and T-wave in the neonates with different sexes. Results  There are significant differences of P-wave amplitude in leads Ⅰ,Ⅱ, aVL, aVR, V₂ and  V₄-V₆, QRS duration in leads Ⅰ,Ⅱ,Ⅲ, aVR, aVL, aVF, V₁ and V₃-V₆, QRS amplitude in leads Ⅲ, aVR, aVF and V₁-V₄, T-wave amplitude in leads aVR, aVL and V₄-V₆, QRS complex morphology in leads Ⅰ,Ⅱ, aVR, aVF, V₁ and V₃-V₆, and T-wave morphology in leads Ⅰ, aVL and V₆ between the male and female neonates (P<0.05). Conclusion  The normal  reference ranges of ECG indexes recorded by 12lead synchronous ECGs in healthy neonates are different between the sexes.

Atrial fibrillation (AF) is the most common arrhythmia and may easily lead to various complications. Therefore, precision medical methods are needed to identify and enhance AF detection to achieve early diagnosis and treatment. Artificial intelligencebased wearable devices are of great value for the screening and management of AF patients. This article reviews the relevant literature on recent applications of such devices for AF screening.

Atrial fibrillation (AF) is one of the most common arrhythmias. It is characterized by concealment, paroxysmal nature, complexity, and high mortality and disability rate; the prevalence rate of AF is on the rise. The new emergence of artificial intelligence technology breaks through the limitations of traditional methods of AF screening, showing unique advantages and broad application prospects in the screening, diagnosis and prediction of AF. Intelligent wearable devices have higher feasibility, specificity and sensitivity in the screening  of AF, with high cost-effectiveness in clinical application.

With biological identification features of universality, portability, uniqueness and stability, electrocardiogram (ECG) as a novel identification method has crossover application in the information field. It enriches and improves the existing biometric identification techniques, and is suitable for customer  identification in the insurance industry. This paper firstly introduces common biometric identification techniques used in the insurance industry, and ECG biometric identification technique and its advantages. It then explains the main content of ECG biometric identification technique, and systematically reviews the latest research advances at home and abroad related to the characteristic points of ECG identification and their extraction. Based on the application practice of ECG identification technique in the domestic insurance industry for nearly 20 years, this paper outlines its technical identification process. Finally, this paper looks forward to the development of the technique in the future. It is aimed to further promote the application of this technique in the insurance industry and other industries.

Objective  To investigate the importance of standard operation of ECG examination for quality control of remote ECG network. Methods  We analyzed ECGs transmitted through the network from January 1,2022 to June 30,2023 at the ECG Network Center of the First People’s Hospital of Xianyang. During the time period, we took every six months as a stage, and performed targeted operation training of ECG examination at each stage. We compared the graphic quality problems and the number of ECGs with quality problems among different stages. Results  After regular ECG operation training for clinical medical staff and instrument maintenance, the quality of ECG graphics has been greatly improved. Conclusion  Standard operation of remote ECG network directly affects the diagnostic accuracy of ECGs. Regular standardized training of ECG operation for clinical medical staff could improve the accuracy of ECG examination results, and avoid the occurrence of medical adverse events.

Atrial fibrillation (AF) has become an important disease that endangers the health of middle-aged and elderly people in China, and it is related to the risk of stroke and death. At present, pathophysiological mechanisms such as atrial structural remodeling, electrical remodeling, inflammation, autonomic nervous system disorders, and non-coding RNA may explain the occurrence and development of AF. The treatment of AF mainly includes anticoagulation, conversion of sinus rhythm, and control of ventricular rate. In addition, antiinflammatory, autonomic nerve intervention and genomics intervention therapy may become  new types of therapies for AF. This article reviews the research progress in the   pathogenesis and treatment of AF.

Heart rate variability (HRV) is a noninvasive index for evaluating cardiac autonomic function, which is closely related to many diseases. It could be used for disease screening, risk stratification, diagnosis and treatment, efficacy evaluation and so on. With the development of technology and optimization of algorithms, the application of HRV in pacemakers and wearable devices has developed  further. This paper mainly illustrates the research background, progress in clinical application and research trends of HRV, and looks forward to the  research directions in the future.

ECG network information system can make early identification, realtime monitoring, critical value warning, diagnosis and rehabilitation management of cardiovascular diseases. The construction of ECG network information system provides a fast track for the expansion of quality medical resources and the sinking of expert resources. This review summarizes the development history and present situation of ECG network information system construction, raises common problems in the construction and application, and looks forward to its development in the future.

In recent years, the combination of remote ECG monitoring and artificial intelligence (AI) technology has greatly assisted the diagnosis and treatment of cardiovascular diseases, and shows extremely broad development prospect. This paper summarizes the progress in the application of AIbased remote ECG monitoring technology in the intelligent diagnosis, hierarchical diagnosis and treatment, prognosis evaluation, and individualized management of acute coronary syndrome. It also introduces the active health intelligent management system of the heart which has been constructed and gradually improved in China on this basis.

对《实用心电学杂志》2023年第2期发表的《心电图动态演变为Aslanger样心肌梗死1例》提出疑问，认为该病例中的心电图改变实为急性下壁合并正后壁ST段抬高型心肌梗死的动态演变，而并非Aslanger样改变或Aslanger征。

Blood pressure (BP) is one of dynamic physiological variables. Besides BP level itself, abnormal blood pressure variability (BPV) is also a risk factor of cardiovascular disease  in the population at high cardiovascular risk. Abnormal BPV is associated with the occurrence, progression, and severity of damage to target organs such as the heart, brain, kidneys and blood vessels. It will result in increased risks of cardiovascular events, and incidences of cardiovascular and allcause mortalities while  it is also an independent risk factor. In the risk stratification for cardiovascular diseases, besides paying attention to BP level, BPV monitoring should also be a part of routine clinical practice. This article mainly reviews the influence of abnormal BPV on related diseases, and the research advance in its clinical application.

Brugada wave is a special ECG pattern that presents as a “triad” of right bundle branch block, STsegment elevation in the right chest lead, and T wave inversion. It could lead to arrhythmia and sudden cardiac death. It has been previously considered that Brugada wave is associated with genetics, electrophysiological mechanism, nerve crest hypothesis and so on. The latest studies have found that mutations in mitochondrial DNA and tRNA, inflammation, and myocardial stroma abnormalities may also be involved in the occurrence and development of Brugada wave. This paper mainly reviews the latest research progress of the electrocardiographic mechanism of Brugada wave.

 Objective  To analyze the value of exercise stress test (EST) and related parameters on diagnosing coronary heart disease (CHD), and to explore the influence of individual factors [such as age, sex and body mass index(BMI)] on its diagnostic accuracy. Methods  We selected 439 patients who had performed treadmill or bicycle exercise test and coronary angiography (CAG). There were 318 CAG positive patients and 121 negative cases among those patients. The sensitivity and specificity of their EST results were observed. All the enrolled patients were grouped according to age, sex, BMI, the number of lesioned vessels, the lesioned vessels whether including the left main artery (LM) and(or) the proximal branch of the left anterior descending artery (LAD1), and the presence or absence of ventricular arrhythmias. The reference value of EST parameters on the definite diagnosis of CHD was analyzed in each group.Results  The sensitivity and specificity of EST in diagnosing CHD is separately 81.22% and 34.71%. The true positive rate of the multibranch coronary artery lesion group is significantly higher than that of the singlebranch vascular lesion group (88.12% vs. 73.96%, P=0.011), however its false negative rate is lower than that of the singlebranch vascular lesion group (11.88% vs. 26.04%, P=0.011). The true positive rate of the LM and(or) LAD1 lesion group does not vary significantly from that of the nonLM and(or) LAD1 lesion group (76.92% vs. 8602%, P=0.103). In the EST true positive group, the peak heart rate (HR) during exercise, attainment rate of target HR, and 1 and 2 min HR during the recovery period are all lower than those in the false positive group (P＜0.05). Among the true positive cases, the peak HR during exercise, attainment rate of target HR, and 1 and 2 min HR during the recovery period of the singlebranch vascular lesion group are all higher than those of the multibranch coronary artery lesion group (P＜0.05). The incidence of ventricular arrhythmias of the true positive group is significantly higher than that of the false positive group (63.06% vs. 18.02%, P=0.048) and the false negative group (63.06% vs. 7.21%, P=0.046). Conclusion  EST has some diagnostic value for CHD. For the elderly overweight males with abnormal peak HR during exercise, attainment rate of target HR, and 1 and 2 min HR during the recovery period, and with ventricular arrhythmias, positive EST results suggest further CAG examination. For the patients with high suspicion of CHD and negative EST results, the related individual factors should be comprehensive analyzed.

Besides conventional chemotherapy, cancer therapy also includes biotargeted therapy, endocrine therapy and immune checkpoint inhibitor therapy and so on at present. Cardiovascular adverse events associated with cancer therapy arouse much attention, among which QT interval prolongation as an abnormal ventricular repolarization phenomenon related to many cancer therapeutic drugs may induce torsades de pointes. Currently known factors that affect QT interval include medications, heart rate, electrolyte disturbances, etc. Based on the latest research progress at home and abroad, this paper reviews the measurement and influencing factors of QT interval, grading of QTc related adverse events, antitumor drugs leading to QT interval prolongation and adjuvant  medications, and monitoring and management strategies of QT interval in patients with cancer therapy.

Based on a brief introduction to fetal electrocardiogram (FECG), this paper illustrates the clinical application of FECG technology in recent years in aspects such as detecting fetal arrhythmias and monitoring fetal intrauterine hypoxia in patients with pregnancyinduced hypertension syndrome. It sorts out the limitations of FECG itself. This paper also summarizes the progress of FECG signal processing techniques, and looks forward to the development prospect of FECG in the future.

Objective To assess the accuracy of wearable electrocardiogram ( ECG) monitoring device for detecting arrhythmias ( sinus rhythm, premature ventricular contraction premature atrial contraction, and atrial fibrillation), and heart rate in a clinical. Methods A total of 321 volunteers (875 ECG records) participated in this study, including 146 males ( 531 ECG records) and 175 females ( 344 ECG records). A wearable ECG monitoring device was employed to record ECGs for detecting arrhythmias and heart rate. The detection results were compared with physicians clinical diagnostic results based on 12-lead ECG machine (regraded as the gold standard for diagnosing arrhythmias and detecting heart rate). Accuracy and consistency evaluation of the two detection methods was conducted in all the subjects, including accuracy, sensitivity, specificity, F1 score, area under curve (AUC) of the receiver operating characteristic curve, Bland-Altman consistency analysis, mean absolute error, and correlogram. Results Regarding arrhythmia identification, wearable ECG monitoring device exhibits impressive performance metrics, with an AUC of 0. 98, accuracy of 0. 98, sensitivity of 0. 96, specificity of 0. 99, and an F1 score of 0. 96. In terms of heart rate monitoring, a robust correlation between the wearable ECG monitoring equipment and the ECG machine is evident, with a substantial total correlation coefficient of 0. 84 (P< 0. 01). Bland-Altman consistency analysis reveals that the two methods display a mean difference of - 0. 97 times per minute, a mean standard deviation of 8. 02 times per minute, and a 95% confidence interval ranging from -16. 69 to 14. 75 within an acceptable level. Conclusion Wearable ECG monitoring device can accurately detect arrhythmias and heart rate.

Since its first clinical application 120 years ago, electrocardiogram (ECG) has still been one of the most important routine examinations in clinical practice. The rapid popularity of portable, remote ECG and cloud ECG platforms accelerates the promotion of ECG technology—from hospitals to the society, family and even everyone. The arrival of body surface three-dimensional electroanatomical mapping visualizes the presentation of abstract ECG morphologies, and clearly reveals the origin of arrhythmia and ECG signal conduction process. This amounts to a “pathological anatomy” like gold-standard validation diagnosis for the ECG. Through deep learning, artificial intelligence (AI)-ECG can explore the fields that cannot be interpreted by ECG before, which greatly expands the connotation of ECG. This paper briefly reviews the development process of ECG technology from remote ECG, three-dimensional ECG and portable ECG to AI-ECG in the past 120 years, and looks forward to its development trend in the future.