JOURNAL OF PRACTICAL ELECTROCARDIOLOGY

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JOURNAL OF PRACTICAL ELECTROCARDIOLOGY

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JOURNAL OF PRACTICAL ELECTROCARDIOLOGY

	2014 Vol.23 Issue.4 Published 2014-08-28

Article

	229	Interpretation of ESC/ACCF/AHA new guidelines on antithrombotic therapy for acute ST-segment elevation myocardial infarction

		Acute ST-segment elevation myocardial infarction(STEMI) is an acute cardiovascular event with coronary thrombosis. Antithrombotic runs through the whole process of both emergent percutaneous coronary intervention and thrombolytic therapy. In recent years, numerous new guidelines about the STEMI have been issued successively by European Society of Cardiology(ESC), American College of Cardiology Foundation(ACCF) and American Heart Association(AHA), in view of some of the published results of large randomized clinical trials. The new guidelines state that once acute STEMI is identified, immediate antiplatelet and anticoagulant therapy should be launched. The loading doses of aspirin (300 mg) and ADP receptor antagonists (clopidogrel 300-600 mg, prasugrel 60 mg, ticagrelor 180 mg) are in the front of antiplatelet therapy. The ESC guidelines prefer ticagrelor and prasugrel .The two guidelines employed a single daily maintenance dose of lowdose aspirin (75-100 mg/d). In emergency PCI, the guidelines recommend that low molecular weight heparin is still important but less glamorous than before and its sustained time is no longer than 8 days.Meanwhile, based on efficacy and safety considerations, bivalirudin would be more preferable in STEMI undergoing emergency PCI , especially for the patients with high risk of bleeding.
		2014 Vol. 23 (4): 229-231 [Abstract] ( 1011 ) [HTML 1KB] [ PDF 929KB] ( 1605 )

	232	Curative effect evaluation of cardiac resynchronization therapy on chronic heart failure patients

		Objective To observe the clinical efficacy of cardiac resynchronization therapy(CRT) in patients with chronic heart failure(CHF). MethodsThirtysix CHF patients were selected who were successfully implanted with CRT in our hospital between December 2010 and December 2013. Before and 6 months after the implantation, the enrolled patients underwent NYHA classification and evaluation of 6minute walk test, and were carried out echocardiography inspections to evaluate left ventricular functional indices such as left ventricular ejection fraction(LVEF), left ventricular mass index(LVMI), left ventricular end diastolic volume index(LVEDVI), left ventricular end systolic volume index(LVESVI), etc. Differences of the above mentioned indices before and 6 months after the treatment were analysed by t test. ResultsSix months after CRT implantation, the indices of LVEF, LVMI, LVEDVI, LVESVI, and NYHA cardiac function classification and outcomes of 6minute walk test were markedly improved, with statistically significant differences(P＜0.05). Conclusion CRTD proves to improve the cardiac function of CHF patients significantly and thus elevate their life quality and exercise tolerance.
		2014 Vol. 23 (4): 232-235 [Abstract] ( 1361 ) [HTML 1KB] [ PDF 901KB] ( 1531 )

	236	Changes of ambulatory electrocardiography, QT dispersion, and heart rate variability in nasopharyngeal carcinoma patients after radiotherapy

		ObjectiveTo investigate the changes of ambulatory electrocardiography(AECG), QT dispersion(QTd), and heart rate variability(HRV) in patients with nasopharyngeal carcinoma(NPC) after radiotherapy. Methods Before and after 3 stages of radiotherapy with different doses(15-25 Gy, 35-45 Gy, and 55-65 Gy, respectively), 40 cases with NPC underwent AECG monitoring and were observed the changes of AECG, QTd, corrected QT dispersion(QTcd), and HRV indices of time domain and frequency domain caused by radiotherapy.ResultsBy comparing each index of AECG before and after 3 stages of radiotherapy in NPC patients, we found that: (i) there was no statistically significant difference in the incidences of supraventricular arrhythmia, ventricular arrhythmia, and ST-T changes(P＞0.05); between QTd and QTcd, there was no statistically significant difference(P＞0.05); in the HRV analysis, there was no statistically significant difference either in time domain indices of SDNN, rMSSD, and pNN50 or frequency domain indices of TP, LF, HF and LF/HF(P＞0.05). Pairedcomparison implied that VLF value after the 3 stages of radiotherapy was significantly lower than that before the treatment, and the difference was statistically significant(P＜0.05).Conclusion (i) The trend of the incidence ventricular arrhythmia was similar to that of ST-T changes, which showed an uptrend at a radiation dose of 15-25 Gy, a downtrend at a radiation dose of 35-45 Gy, and a strong uptrend at a radiation dose of 55-65 Gy. (ii) The indices of QTd and QTcd exhibited a downtrend at a radiation dose of 15-25 Gy, an uptrend at a radiation dose of 35-45 Gy, and recovered to pretherapeutic level at a radiation dose of 55-65 Gy. (iii) Among the HRV indices, the higher the radiation dose was, the more significantly VLF decreased. It hints that radiotherapy on NPC patients affects longterm regulating of body temperature, reninangiotensin system and humoral factors, enhances sympathetic nerve activity, influences sympathetic nervevagus equilibrium, and thus impacts the regulating of autonomic nerve and results in abnormal ECG.
		2014 Vol. 23 (4): 236-240 [Abstract] ( 1603 ) [HTML 1KB] [ PDF 1103KB] ( 1545 )

	241	Electrocardiographic changes of dual atrioventricular node pathways revealed by unfixed PR interval on ambulatory electrocardiography

		ObjectiveTo investigate the electrocardiographic changes of dual atrioventricular node pathways revealed by unfixed PR interval on ambulatory electrocardiograph(AECG).MethodsRetrospective analysis was made on 44 patients with unfixed PR interval on AECG.ResultsAtypical seconddegree atrioventricular block Mobitz typeⅠphenomenon revealed a high incidence rate of dual atrioventricular node pathways, mainly occurring in the form of bradycardia and at night, premature ventricualr contraction taking the second place. ConclusionExcessive prolongation of PR interval caused by slow pathway conduction will influence the electrical and mechanical activity of heart or atrioventricular synchrony, and furtherly result in cardiac insufficiency in a long term. Therefore, the above phenomenon needs to be emphasized on an AECG report.
		2014 Vol. 23 (4): 241-244 [Abstract] ( 1318 ) [HTML 1KB] [ PDF 2647KB] ( 1795 )

	245	Relationship between ECGs of 315 HIV/AIDS patients and CD4⁺ cell

		Objective To explore the relationship between electrocardiograms(ECGs) from 315 HIV/AIDS patients and CD4⁺cell. MethodsAccording to the count of CD4⁺cells, the enrolled 315 patients were divided into group A and group B, whose routine ECGs were made comparative analysis.ResultsBetween the 2 groups, there were statistically significant differences in the occurrences of abnormal ECGs, nodal tachycardia, high voltage in left ventricle, and ST-T changes(P＜0.05). There was no statistically significant differences in the occurrences of sinus bradycardia, ectopic beat, axis deviation, and bundle branch block(P＞0.05). ConclusionHIV virus and highintense antiviral therapy significantly damage cardiovascular system, which are closely related to the level of CD4+ cells and disease progression.
		2014 Vol. 23 (4): 245-246 [Abstract] ( 934 ) [HTML 1KB] [ PDF 880KB] ( 1431 )

	247	Clinical characteristics of 132 patients with low voltage on ECG

		Objective To explore the clinical significance and pathogeny of low voltage changes on ECG. MethodsThe data of 132 patients were collected who were diagnosed with low voltage by surface ECG and were in hospital from June 2013 to March 2014. Their pathogeny and clinical characteristics were analysed.Results① Among the 132 patients, there were 32 patients(24%) with precordial low voltage, 87(66%) with limb low voltage, and 13(10%) with both precordial and limb low voltage. ② Sixtynine patients(52%) suffered from cancers, lung cancer ranking at the first place.③ Of all the patients with cardiac functional insufficiency, anterior wall infarction and dilated cardiomyopathy were the main causes of diseases.ConclusionCancers might be the main causes of low voltage on ECG.
		2014 Vol. 23 (4): 247-248 [Abstract] ( 1468 ) [HTML 1KB] [ PDF 876KB] ( 2764 )

	249	Level of plasma apelin and its significance in patients with different types of atrial fibrillation

		ObjectiveTo explore the relationship among the level of plasma apelin in patients with different types of atrial fibrillation(AF), N-terminal proB-type natriuretic peptide(NT-proBNP), and left atrial diameter(LAD).MethodsEightyfive AF patients were divided into three groups, including 31 cases of paroxysmal AF(group B), 29 cases of persistent AF(group C), and 25 cases of permanent AF(group D) while 26 inpatients without AF were enrolled as control group over the same period. For the four groups, the levels of plasma apelin and NT-proBNP were detected, LAD was measured by echocardiography, and statistical analysis was performed.ResultsThe levels of plasma apelin in groups B, C, and D were significantly lower than that in group A(P<0.05 for all), and the level of group D was significantly lower than that of groups B and C(P<0.05 for all). The difference of levels of plasma apelin was not statistically significant between group B and group C(P>0.05). Compared with group A, the values of NT-proBNP in groups B, C, and D significantly increased(P<0.05 for all), and the value was the highest in group D. The difference of the value of NT-proBNP was not statistically significant between group B and group C(P>0.05). There was statistically significant difference of LAD among groups A, B, C, and D(P<0.05 for all), and the values increased gradually. Multiple correlation analysis revealed that the level of plasma apelin was negatively correlated with NTproBNP and LAD(r=-0.28,-0.32,respectively; P<0.05 for both).ConclusionThe decreased plasma apelin level was correlated with the onset and perpetuation of AF, which may be involved in atrial remodeling through antifibrosis mechanism．
		2014 Vol. 23 (4): 249-252 [Abstract] ( 1095 ) [HTML 1KB] [ PDF 909KB] ( 1633 )

	253	Clinical analysis of fragmented QRS complex in non-ST segment elevation acute coronary syndrome patients

		Objective To explore the relationship between fragmented QRS complex(fQRS) and the risk stratification and short-term prognosis of non-ST segment elevation acute coronary syndrome(NSTE-ACS) patients. MethodsOne hundred and sixty NSTE-ACS patients were randomly selected, including 72 high-risk cases, and 88 non-high-risk(moderateand low-risk) cases. Between high-risk and non-high-risk NSTE-ACS patients, the incidence of fQRS was compared. Between fQRS group and non-fQRS group, the incidence of cardiac events of NSTE-ACS patients in hospital was made comparative analysis. ResultsThe incidence of fQRS among high-risk NSTE-ACS patients(20 case, 27.78%) was higher than that of non-high-risk NSTE-ACS patients(12 case, 13.63%), with statistically significant difference(P<0.05). Among patients with fQRS, the incidences of ventricular arrhythmias, heart failure(LVEF≤40%), cardiogenic shock, and cardiac death were 68.75%, 43.75%, 18.75%, and 12.5%, respectively while the incidences of the above cardiac events were separately 45.31%, 21.88%, 5.47%, and 1.56% in nonfQRS group. And the differences between the two groups were all statistically significant(P<0.05). ConclusionThe incidence of fQRS among high-risk NSTE-ACS patients was higher, and among NSTE-ACS patients with fQRS, the incidence of cardiac events in hospital was higher, too. Therefore, fQRS may serve as a new index for predicting short-term prognosis of NSTE-ACS and screening patients with a high risk of NSTE-ACS.
		2014 Vol. 23 (4): 253-255 [Abstract] ( 1930 ) [HTML 1KB] [ PDF 895KB] ( 1348 )

	256	Clinical values of limb lead ST segment changes in predicting coronary occlusion sites in patients with acute anterior wall myocardial infarction

		Objective Combining results of coronary angiography, to analyse the predictive values of limb lead ST segment changes for identifying the coronary occlusion sites in patients with acute anterior wall myocardial infarction.MethodsEighty-four patients who had undergone coronary angiography inspections for acute anterior wall myocardial infarction were selected as candidates and their ST segment changes in limb leads of ECG after onset were analysed. ResultsAccording to the results of coronary angiography, at the lesion of the proximal end of anterior descending branch(with or without distal occlusion), ST segment changes in limb leads Ⅱ, Ⅲ, and aVF were mostly expressed as depression≥0.1 mV while elevation or unobvious depression of ST segment in limb leads Ⅱ, Ⅲ, and aVF mostly occurred at the lesion of the distal end of anterior descending branch(without proximal occlusion). ConclusionBy analysing the ST segment changes in limb leads of ECG, coronary occlusion sites can be predicted, which serves as an references for early diagnosis and treatment options for patients with acute anterior wall myocardial infarction.
		2014 Vol. 23 (4): 256-259 [Abstract] ( 1082 ) [HTML 1KB] [ PDF 958KB] ( 1697 )

	260	Analysis of heart rate variability in hypertensives complicating type 2 diabetes

		Objective To analyze the heart rate variability(HRV) of hypertensives complicating type 2 diabetes.MethodsSixty cases of hypertensives complicating type 2 diabetes(group A), 60 cases of hypertensives(group B), and 60 cases of health checkup people(group C) were selected and carried out 24 h ambulatory electrocardiography. The HRV indices were compared among the 3 groups.ResultsFor group A, the standard deviation of normal to normal intervals(SDNN), every 5 minutes average standard deviation(SDANN) and every 5 minutes standard deviation of mean RR intervals(SDNN index) within 1 d, and rate mean square of the differences of successive RR intervals (rMSSD) and percentage of RR intervals differing ＞50 ms(pNN50) were separately (97.88±25.77) ms, (83.24±20.13) ms, (14.55±10.57) ms, (17.95±8.55) ms, and (3.56±2.44)%, significantly lower than those of group B［(122.41±20.33) ms, (104.56±19.73) ms, (45.22±12.45) ms, (22.44±6.44) ms, and (8.83±4.95) %, respectively］ and those of group C［(138.23±22.44) ms, (127.95±21.84) ms, (59.35±16.44) ms, (35.96±14.33) ms, and (13.56±11.24) %, respectively］. And compared with group C, the above HRV indices of group B were also much lower. The differences were all statistically significant(P<0.05).ConclusionFor hypertensives complicating type 2 diabetes, HRV can be applied in identifying the degree of autonomic nerve functional lesions at an early phase. The method proves to be safe, reliable and worthy of clinical promotion.
		2014 Vol. 23 (4): 260-262 [Abstract] ( 1611 ) [HTML 1KB] [ PDF 888KB] ( 1511 )

	263	Investigation on the bonding point of traditional Chinese and Western Chronomedicine through distribution regularity of frequent ventricular premature beat

		Objective To investigate the circadian rhythms of frequent ventricular premature beat within 24 hours and its circadian rhythm of traditional Chinese medicine by observing the temporal distribution of frequent ventricular premature beat in 24 h ambulatory electrocardiography(AECG), and to discuss the bonding point of traditional Chinese and Western Chronomedicine through the 4 time points of Zi(23:00-01:00), Mao(05:00-07:00), Wu(11:00-13:00), and You(17:00-19:00). Methods Four hundred and sixtysix patients were enrolled in the study who had been diagnosed with frequent ventricular premature beat by AECG in our hospital from January 2012 to June 2014 and the diagnostic criteria was the total number of ventricular premature beats＞500 times/d. Their fundamental data and the number of ventricular premature beats per hour were recorded. The distribution data of frequent ventricular premature beat within 24 hours were regarded as circular distribution, from which the average angle was calculated by PEMS 3.1 statistical software, hypothesis testing was performed and the central tendency of the occurrence time of ventricular premature beat was statistically analysed. With the help of SPSS 20.0 statistical package, comparison of ventricular premature beats numbers among different time points was made by variance analysis of repeated measurement. ResultsAmong the enrolled 466 patients, the peak time for the occurrence of ventricular premature beat by AECG was around 17:49, corresponding to You, the period of a day from 17:00 to 19:00, while the least total number of ventricular premature beats fell in Zi(23:00-01:00) and Mao(05:00-07:00). The differences of the total numbers of ventricular premature beats among the 4 time points were statistically significant(P＜0.05). According to the distribution trend chart within 24 hours, the peak time for the occurrence of ventricular premature beat was 18:00 and the down time was 04:00.ConclusionThis study verified the circadian rhythm of frequent premature ventricular beats, and the correspondence between its peak time and You in traditional Chinese medicine. The circadian rhythm was also consistent with Qi activity rule of heart and the coordination between heart and kidney. It made a preliminary exploration on the combination of Chinese and Western Chronomedicine.
		2014 Vol. 23 (4): 263-265 [Abstract] ( 1788 ) [HTML 1KB] [ PDF 1094KB] ( 1502 )

	266	Relationship between heart rate and P wave amplitude

		ObjectiveTo explore the relationship between heart rate and the amplitude of P wave.MethodsTwo hundred and fortyfive patients examined by 24 h ambulatory electrocardiography(Holter) in our hospital were randomly selected. Based on their Holter screenshots including the fastest and the slowest heart rate, the heart rates and P wave amplitudes were measured separately, and the average values of P wave amplitudes in different ranges of heart rates were calculated and compared. The reasons for the changes of P wave amplitudes were analysed. ResultsThere was significant difference between the P wave amplitude at a heart rate over 120 beats/min and the one at a heart rate below 120 beats/min. And there was no obvious correlationship between the increase of P wave amplitude and right atrial enlargement or pulmonary artery hypertension.ConclusionWhen heart rate is over 120 beats/min, the increase of P wave amplitude mainly results from elevated autonomic nerve tension.
		2014 Vol. 23 (4): 266-267 [Abstract] ( 1398 ) [HTML 1KB] [ PDF 912KB] ( 3842 )

	268	Analysis of 6 528 criminals ECGs in physical examination

		Objective To discuss the significance of monitoring criminals-heart health by electrocardiogram(ECG).MethodsECGs of 6 528 criminals were grouped by ages and made comparative analysis.ResultsThere was a positive correlation between age and the total rate of abnormal ECGs.ConclusionCriminals lives and health should be paid attention to. Physical examination needs to be strengthened, especially for people over 48 years old. By observing changes of ECG, the events of cardiovascular disease could be prevented.
		2014 Vol. 23 (4): 268-269 [Abstract] ( 1149 ) [HTML 1KB] [ PDF 1742KB] ( 1683 )

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		2014 Vol. 23 (4): 270-276 [Abstract] ( 1051 ) [HTML 1KB] [ PDF 7091KB] ( 2052 )

	277	Rotor mechanism of arrhythmia and its clinical significance

		Objective The rotor is one of the important mechanisms of arrhythmia. Its formation is related to the vortex shedding and ion channels. Triggers and abnormal cardiac structure can promote the formation and maintenance of rotors. Phase, dominant frequency, Shannon Entropy and CONFIRM mapping are expected for the mapping of rotors, which may improve clinical treatment.
		2014 Vol. 23 (4): 277-291 [Abstract] ( 954 ) [HTML 1KB] [ PDF 12693KB] ( 1516 )

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