JOURNAL OF PRACTICAL ELECTROCARDIOLOGY

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JOURNAL OF PRACTICAL ELECTROCARDIOLOGY

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JOURNAL OF PRACTICAL ELECTROCARDIOLOGY

	2013 Vol.22 Issue.6 Published 2013-12-28

Article

	841	Clinical value of deceleration capacity of heart rate in predicting high-risk patients with hypertrophic cardiomyopathy

		Objective To investigate the applications of deceleration capacity of heart rate(DC) in assessment of autonomic nervous function in patients with hypertrophic cardiomyopathy(HCM) and discuss its clinical value in predicting high-risk patients.MethodsNineteen HCM patients’ and 21 normal persons’ 24 h ambulatory electrocardiography data were analyzed. The two groups were regarded as observation group and control group respectively. DC and HRV time domain indexes (SDNN, rMSSD) were compared between two groups of patients while the relationship between DC and HRV indexes of the observation group were studied with statistical software.ResultsDC and HRV time domain indexes of the observation group were lower than those of control group, with statistically significant differences.The incidence of abnormal DC in observation group was as high as 84.2%, significantly higher than that of control group(P<0.05). It was implied by relevant analytic results that in observation group, DC was positively correlated with SDNN (r=0.618,P<0.05) as well as rMSSD(r=0.557,P<0.05).The incidence of sudden death in DC high-risk group was significantly higher than that of DC low-risk group during a 48-month follow-up.ConclusionDC of HCM patients significantly decreases and has good positive correlation with HRV time domain indexes(SDNN, rMSSD).Therefore, DC can be utilized as a new reliable index for quantitatively detecting autonomic nervous function of HCM patients and screening high-risk cases among them.
		2013 Vol. 22 (6): 841-843 [Abstract] ( 1420 ) [HTML 1KB] [ PDF 914KB] ( 1770 )

	844	Electrocardiogram analysis of young and middle-aged patients with hyperthyroidism

		Objective To explore the diagnostic value of changes on electrocardiogram(ECG) for young and middle-aged patients with hyperthyroidism.MethodsECG data of 75 outpatients who were diagnosed in our hospital with hyperthyroidism for the first time were analyzed. Meanwhile, 75 case of normal persons who were matching with the 75 outpatients in genders and ages were enrolled as the control group and their ECG data were also analyzed. ResultsThere were ECG changes in 37 cases(accounting for 49.33%) of the hyperthyroidism group and in 23 cases(accounting for 30.67%) of the control group, with statistically significant differences(P＜0.05). The ECG changes mainly concentrated on ST segments and T waves. In the aspect of heart rate, the hyperthyroidism group was significantly faster than the control group, with (77.72±12.98) times/min in the former and (71.29±10.14) times/min in the latter, and the differences were statistically significant.In the hyperthyroidism group, the incidence of abnormal ECG of females(61.70%) was obviously higher than that of males(32.14%), with statistically significant differences. Compared with the control group, there were decreased QT interval, prolonged QTc interval and increased amplitude of P wave in the hyperthyroidism group, and the differences were statistically significant.ConclusionThe incidence of abnormal ECG in patients with hyperthyroidism is higher than that in normal group. ECG can provide some reference value for the diagnosis of hyperthyroidism.
		2013 Vol. 22 (6): 844-846 [Abstract] ( 1733 ) [HTML 1KB] [ PDF 882KB] ( 2096 )

	847	Analysis and interpretation of F lead on electrocardiogram for the diagnosis of mirror dextrocardia

		Objective To explore the features of F lead on electrocardiogram(ECG) in diagnosing mirror dextrocardia.MethodsIn health checkup, F lead was utilized to collect mirror dextrocardia ECG which was interpreted afterwards.ResultsThirteen cases of mirror dextrocardia were detected (accounting for 0.018%) by lead F. Each wave of lead Ⅰ in mirror dextrocardia was inverted, that was, P, QRS and T waves were inverted; The forms of waves in leads F₂(Ⅱ) and F₆ (Ⅲ ), and leads F₃(aVR) and F₁(aVL) were interchanged; The forms of waves in leads V₃R and V₅R were similar to leads V₃and V₅ at normal time, which represented the left ventricular waves.The leads V₁ and V₂represented the right ventricular waves.ConclusionThe characteristics of the mirror dextrocardia indicated that: leads F₁ (aVL) and F₂ (Ⅰ) of P waves displayed mirroring QRS waves; The main waves of P-QRS-T complex in leads F₁ (aVL), F₂ (Ⅰ), F₃ (－aVR) and F₄ (Ⅱ) were downward, with rS type and increasing trend in the amplitude of R wave; The lead F₅ (aVF) of QRS wave stayed unchanged; The chest leads V₁~V₆ was in the shape of rS type, with progressively decrease in the amplitude of R wave and relatively increase in the depth of S wave and in the ratio of R/S; The R wave of lead V₁ was high and sharp; There were usually accompanied with other ECG changes.
		2013 Vol. 22 (6): 847-849 [Abstract] ( 1606 ) [HTML 1KB] [ PDF 2657KB] ( 2509 )

	850	Application of single lead on the diagnosis of wide QRS complex

		Objective To verify the values of R-wave peak time(RWPT) inⅡlead, form of aVR lead and ratio of Vi to Vt in the differential diagnosis of wide QRS complex.MethodsBy 12-lead electrocardiograms of 261 patients specifically diagnosed with premature ventricualr contraction and 127 cases with atrial premature beats complicated with intraventricular aberrant conduction, their RWPT inⅡlead, forms of aVR lead and values of Vi/Vt were retrospectively analyzed.The sensitivity, specificity, positive and negative predictive values and accuracy of the above three methods in the differential diagnosis of wide QRS complex were compared.The identification value of the first three steps of aVR lead form method was also compared. Results① In the identification of wide QRS complex, differences between the methods of RWPT inⅡlead and form of aVR lead weren't statistically significant(P>0.05) and the two methods shared the same accuracy, sensitivity, specificity and positive predictive value. Compared with the other two methods, accuracy and sensitivity of Vi/Vt ratio method were lower(P＜0.05) while specificity and positive predictive value were higher(P>0.05).② With the application of aVR lead form method, the first and the third step had relatively higher specificity and the third step had relatively higher positive predictive value.ConclusionThe methods of RWPT inⅡlead and form of AVR lead were simple, convenient and accurate in the differential diagnosis of wide QRS complex, owning superiority over Vi/Vt ratio method.
		2013 Vol. 22 (6): 850-853 [Abstract] ( 1536 ) [HTML 1KB] [ PDF 1631KB] ( 1554 )

	854	Clinical study on Tpeak-Tend interval changes of patients with acute exacerbation of chronic obstructive pulmonary disease


		2013 Vol. 22 (6): 854-856 [Abstract] ( 1484 ) [HTML 1KB] [ PDF 1007KB] ( 1875 )

	857	Clinical analysis of obvious U wave appearing in patients with stroke

		ObjectiveTo study the significance of obvious U wave (The criterion: the amplitude of U wave of every lead is larger than half of the amplitude of T wave of the same lead) inspected by electrocardiogram(ECG) of patients with stroke.MethodsRetrospectively analyse 546 cases of patients definitely diagnosed with stroke and separately carry out ECG examinations and biochemical tests.ResultsThere were 22 cases who were observed obvious U waves through ECG, accounting for 4.03% of all the 546 cases. Two cases were detected obvious U waves complicated with hypokalemia, accounting for 0.366% (χ²=17, P＜0.001).ConclusionThe obvious U wave by ECG is not necessarily caused by hypokalemia. We should give compositive analysis clinically.
		2013 Vol. 22 (6): 857-859 [Abstract] ( 1334 ) [HTML 1KB] [ PDF 1406KB] ( 1696 )

	859


		2013 Vol. 22 (6): 859-859 [Abstract] ( 606 ) [HTML 1KB] [ PDF 1084KB] ( 1241 )

	860	Observation of serum NT-proBNP level 12 months after operations of right ventricular outflow tract septum pacing and right ventricular apex pacing

		ObjectiveTo compare the effect on cardiac systolic functions between the patients having accepted the operations of right ventricular outflow tract septum (RVOTS) pacing and right ventricular apex(RVA) pacing 12 months before.MethodsOne hundred patients with sick sinus syndrome who had implanted VVI pacemaker for the first time were observed and randomly divided into RVOTS-pacing group and RVA-pacing group. The levels of NT-proBNP were detected before and 12 months after the pacemaker implantation.ResultsIn RVOTS-pacing group, there was no significant difference of serum NT-proBNP level before and 12 months after the operation(P>0.05) while there was a significant increase in RVA-pacing group. The differences of serum NT-proBNP levels between the two groups 12 months postoperatively also showed statistical significance(P<0.05).ConclusionCompared with RVA pacing, RVOTS pacing had less influence on cardiac systolic function and more similar to physiological pacing.
		2013 Vol. 22 (6): 860-862 [Abstract] ( 956 ) [HTML 1KB] [ PDF 1196KB] ( 1907 )

	862


		2013 Vol. 22 (6): 862-862 [Abstract] ( 568 ) [HTML 1KB] [ PDF 1071KB] ( 1342 )

	863	The diagnostic values of QT dispersion and ischemic ST segment depression for coronary heart disease during treadmill exercise test

		Objective To analyze the diagnostic values of QT dispersion(QTd) and changes of ST segment for coronary heart disease during treadmill exercise test(TET).MethodsThe changes of QTd and ST segment were obseved in 158 patients diagnosed with coronary heart disease by coronary arteriongraphy and 96 controls whose TET results were negative.ResultsCompared with the controls, QTds of the patients with coronary heart disease were significantly increased(P<0.05) and the increase was correlative with ST segment depression.The diagnostic accuracy of QTd≥60 ms for coronary heart disease was higher than that of ST segment. ConclusionThe changes of QTd during TET can be utilized as a new index in diagnosing and treating coronary heart disease.
		2013 Vol. 22 (6): 863-864 [Abstract] ( 1041 ) [HTML 1KB] [ PDF 868KB] ( 1895 )

	865	Effect of psychological support on heart rate turbulence in patients with coronary heart disease accompanied with depression

		Objective To investigate the effect of psychological support on heart rate turbulence(HRT) in patients with coronary heart disease accompanied with depression. MethodsOne hundred and ten outpatients and inpatients with coronary heart disease in the Department of Cardiology of our hospital were enrolled and their depression status were assessed by Zung’s self-rating depression scale(SDS). Fifty patients with coronary heart disease complicated with depression were chosen as the subject investigated.Fifty cases were randomly divided into observation group(25 cases)and control group(25 cases).Besides conventional drugs, the observation group accepted psychological support treatments.All enrolled patients were performed 24-hour ambulatory electrocardiography.Their HRT parameters including HRT onset(TO) and HRT slope(TS) and SDS scores were measured, respectively one week after being chosen and two weeks after being treated.ResultsCompared with the control group, the depression status of the observation group was improved and HRT was enhanced further.ConclusionHRT of patients with coronary heart disease complicated with depression shows significant decrease.Combining drug therapy with psychological support can elevate patients’ HRT, improve the function of vagus nerve and the prognosis.
		2013 Vol. 22 (6): 865-867 [Abstract] ( 1169 ) [HTML 1KB] [ PDF 881KB] ( 1369 )

	868	Investigation on diagnostic value of dynamic electrocardiogram for sick sinus syndrome

		ObjectiveTo explore the diagnostic value of ambulatory electrocardiography (AECG) in patients with sick sinus syndrome(SSS). MethodsOne hundred and sixty SSS patients and another 160 healthy cases were enrolled in 24 hour AECG examination, respectively as experimental group and control group. The difference of examination results was compared between the two groups.ResultsThe total heart beats and average heart rate during 24 hours and maximum and minimum heart rate of experimental group were lower than those of control group, with statistically significant differences(P＜0.05). The incidence of arhythmias such as sinus bradycardia, sinus arrest and atrioventricular block was significantly higher than that of control group, also with statistically significant differences(P＜0.05).ConclusionsAECG is a reliable method for the diagnosis of SSS.
		2013 Vol. 22 (6): 868-869 [Abstract] ( 1128 ) [HTML 1KB] [ PDF 906KB] ( 1536 )

	870


		2013 Vol. 22 (6): 870-873 [Abstract] ( 1328 ) [HTML 1KB] [ PDF 2919KB] ( 2000 )

	874


		2013 Vol. 22 (6): 874-887 [Abstract] ( 1170 ) [HTML 1KB] [ PDF 20185KB] ( 1370 )

	887


		2013 Vol. 22 (6): 887-887 [Abstract] ( 606 ) [HTML 1KB] [ PDF 853KB] ( 1157 )

	888	The research of fragmented QRS complex in patients with myocardial infarction

		In recent years, due to the widespread application of early therapies such as thrombolysis and percutaneous coronary intervention, the incidence of Q-wave myocardial infarction significantly decreases. Meanwhile, the duration and amplitude of Q waves will gradually decrease or even disappear over time, which significantly increases the incidences of non-Q-wave myocardial infarction(NQMI) and non-ST-segment elevation myocardial infarction(NSTEMI). However, neither NQMI nor NSTEMI has characteristic changes on 12-lead electrocardiogram. For this reason, both of them are prone to be missed clinically and thus other new specific indexes are needed. Fragmented QRS complex (fQRS) is a new indicator which shows high sensitivity and specificity in identifying and predicting myocardial infarction. In this paper, we will elaborate the mechanism of fQRS and the role it plays in the diagnosis of myocardial infarction.
		2013 Vol. 22 (6): 888-892 [Abstract] ( 1628 ) [HTML 1KB] [ PDF 1650KB] ( 1911 )

	893	The research status on biochemical and physical indicators: the joint assessment of radiation-induced heart disease

		Radiation-induced heart disease（RIHD） proves to be one of the common adverse reactions due to radiotherapy for thoracic neoplasms. It can significantly increase the risk of coronary artery disease, pericardial disease, valvular heart disease and sudden death. It has been found by research that serum cardiac troponin I (cTnI) and heart rate variability(HRV) could be utilized in the evaluation of RIHD, but difficult to be used in early diagnosis.Recent studies have shown the important relationship between the incidence of RIHD and the volume and dose of heart irradiated.Therefore we intend to test serum cTnI, HRV and dose-volume histogram jointly to predict the disease, and explore effective biochemical and physical indicators furtherly for early prediction of heart injury due to radiotherapy for thoracic neoplasms, in order to provide important reference for clinical treatment.
		2013 Vol. 22 (6): 893-895 [Abstract] ( 1332 ) [HTML 1KB] [ PDF 887KB] ( 1615 )

	896	New viewpoints of lead aVR for clinical applications

		Among electrocardiographic leads, lead aVR usually receives less attention in clinical evaluation of electrocardiogram (ECG).However recent researches reveal important roles lead aVR plays in various ways.The classical clinical applications of lead aVR include the identifications of sinus rhythm and axis and the diagnosis of dextrocardia, exchanges of the upper limb leads and ventricular hypertrophy. There were several other clinical applications discovered recently. Firstly, when acute coronary syndrome attacks, ST segment elevation in lead aVR could indicates the stenosis of left main coronary artery, proximal left anterior descending or three-vesseled coronary artery disease. When ST-segment-elevation typed myocardial infarction occurs, elevation or depression of ST segment could serve as independent predictor of mortality of inpatients and be utilized in the risk stratification. Secondly, lead aVR could be applied in differentiating wide or narrow QRS tachyarrhythmias. Combined with lead V₁ and V₂, lead aVR of surface ECG can be utilized in the estimation of the cycle length of right atrial fibrillation. It implies that the amplitude of P wave in lead aVR was a powerful predictor of postoperative atrial fibrillation. And the morphology of R wave in lead aVR could be helpful in riskstratifying patients with Brugada syndrome. Thirdly, when right ventricle is overloaded, ST segment elevation in lead aVR can provide some valuable information for predicting the death rate(by univariate regression analysis) and complication of acute pulmonary embolism. The R wave delay in lead aVR is proved to be an independent predictor of overloaded right ventricle and more prevalent in patients with pulmonary stenosis.Among patients with idiopathic pulmonary arterial hypertension, R wave in lead aVR >4 mm in combination with R in V₁ >6 mm, R/S in V₁ >1, R/S in V₅to R/S in V₁ <0.04 and P in Ⅱ>2.5 mm could confirm the diagnosis of right ventricular hypertrophy. Fourthly, when Wolff-Parkinson-White syndrome probably occurs, a three stepwise criteria which is composed of the presence of both PR interval≤120 ms and PR dispersion≥20 ms, the absence of initial forward wave(septal R wave) in lead aVR and horizontal QRS transition in lead V₁ or before could be utilized in identifying ventricular preexcitation and the criteria proves to be very sensitive and specific. Furthermore, a serial monitoring of R wave and R/S ratio in lead aVR might be informative in predicting the recovery of consciousness from toxicity due to tricyclic antidepressants overdose. In addition, when acute pericarditis attacks, ST segment depression and PR segment elevation in lead aVR become characteristic representations of the disease, that is, knuckle sign, which may help in the diagnosis of acute pericarditis for it’s possibly the earliest and the only change of ECG.
		2013 Vol. 22 (6): 896-903 [Abstract] ( 1450 ) [HTML 1KB] [ PDF 1833KB] ( 2696 )

	904	Application of RR-Lorenz plot to identify the properties of atrial fibrillation with wide QRS complex

		Female, 75 years old, suffering from coronary disease and atrial fibrillation. The 24-hour Holter detection found intermittent appearance of wide and abnormal QRS complex，the time limit of which was 120 ms. There was no compensatory pause following QRS complex and RR intervals were unequal. It was diagnosed as intermittent intraventricular block while idioventricular rhythm couldn’t be excluded.By analyzing RR-Lorenz plot, part of points of the patient scatterred between atrioventricular node functional refractory period(AVNFRP) limit and X-axis, with the slope of B-line approaching zero. Therefore, the diagnosis was atrial fibrillation with idioventricular rhythm.
		2013 Vol. 22 (6): 904-905 [Abstract] ( 1431 ) [HTML 1KB] [ PDF 1523KB] ( 1940 )

	906


		2013 Vol. 22 (6): 906-907 [Abstract] ( 1337 ) [HTML 1KB] [ PDF 2616KB] ( 1711 )

	908


		2013 Vol. 22 (6): 908-910 [Abstract] ( 1074 ) [HTML 1KB] [ PDF 3028KB] ( 1776 )

	910


		2013 Vol. 22 (6): 910-910 [Abstract] ( 643 ) [HTML 1KB] [ PDF 1686KB] ( 1352 )

	911


		2013 Vol. 22 (6): 911-9112 [Abstract] ( 1441 ) [HTML 1KB] [ PDF 1802KB] ( 1734 )

	913


		2013 Vol. 22 (6): 913-916 [Abstract] ( 574 ) [HTML 1KB] [ PDF 541KB] ( 1106 )

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