JOURNAL OF PRACTICAL ELECTROCARDIOLOGY

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JOURNAL OF PRACTICAL ELECTROCARDIOLOGY

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JOURNAL OF PRACTICAL ELECTROCARDIOLOGY

	2015 Vol.24 Issue.1 Published 2015-02-28

Article

	1	Research progress on early repolarization syndrome
		HU Xi-Tian
		It is over 70 years since early repolarization syndrome(ERS) was found for the first time. It has long been regarded as benign electrocardiographic variation and has never aroused enough attention until the relationship between ERS and malignant arrhythmiainduced sudden cardiac death was reported in 2008. How to screen the patients at high risk of sudden death is the hotspot of research. The information of ERS risk stratification can be provided by Genomics, ion channels, and Jwave morphology, an integrated application of which may work better. At present, ERS treatment is limited to secondary prevention, and radiofrequency ablation and ICD implantation may save the lives of patients.
		2015 Vol. 24 (1): 1-8 [Abstract] ( 1390 ) [HTML 1KB] [ PDF 7407KB] ( 1605 )

	9	Premature ventricular beats originating from the cardiac summit: anatomical and electrocardiographic features relevant to ablation
		SUN Yuan-Jun, ZHANG Shu-Long
		Cardiac summit is a crux area including the region of great cardiac vein(GCV) and anterior interventricular vein(AIV), aortomitral continuity(AMC), left coronary cusp (LCC), and posterior right ventricular outflow(RVOT). Since cardiac summitoriginated premature ventricular beats(PVBs) is characteristic in electrocardiogram(ECG), surface body ECG helps to make reasonable ablative strategy before operation by positioning the possible origin of PVBs. 
		2015 Vol. 24 (1): 9-12,15 [Abstract] ( 2073 ) [HTML 1KB] [ PDF 17373KB] ( 1132 )

	13	Striving to increase understanding and raise diagnosistreatment level of arrhythmiainduced cardiomyopathy
		WANG Fu-Jun, LUO Ya-Xiong, XIANG Hong-Ju
		In the past, arrhythmia-induced cardiomyopathy has long been defined as a kind of clinical syndrome. Its pathogenic mechanism is long-standing tachycardia impairs left ventricular function which results in enlarged ventricle, declined cardiac function, and finally heart failure. After] heart rate or tachyarrhythmia is controlled, cardiac function can be recovered partially or fully, and the clinical syndrome can also be called tachycardia-induced cardiomyopathy. With the progress of cardiac electrophysiology, more and more types of arrhythmias can be cured once and for all. Various types of arrhythmias are found which can induce cardiomyopathy. Therefore, the concept of tachycardia-induced cardiomyopathy has developed and been transformed into the concept of arrhythmia-induced cardiomyopathy. Different types of arrhythmia-induced cardiomyopathy differ in triggering mechanisms and mainstream therapies.
		2015 Vol. 24 (1): 13-15 [Abstract] ( 965 ) [HTML 1KB] [ PDF 939KB] ( 1643 )

	16	Bradycardia-induced cardiomyopathy
		XIANG Hong-Ju, ZHAN Hong-Ji, WANG Fu-Jun
		Not only persistent or recurrent tachycardia, but also long-lasting bradyarrhythmia can induce cardiomyopathy. Its pathogenesis is not clear, which is possibly related to significantly prolonged ventricular diastole, overloaded volume, loss of atrioventricular sequential contraction, changes of ventricular activation sequence, heterogeneity of ventricular contraction, and myocardial hypoperfusion, etc. Diagnosis of the disease is mainly based on a medical history of bradycardia, cardiac dilatation, and cardiac functional insufficiency. By cardiac pacemaker(especially three-chamber pacemaker) therapy, heart function can be back to normal.
		2015 Vol. 24 (1): 16-17,21 [Abstract] ( 1687 ) [HTML 1KB] [ PDF 943KB] ( 1612 )

	18	Tachycardia-induced cardiomyopathy
		ZHOU Zhao-Shun, ZHAO 恩Peng, WANG Fu-Jun
		Tachycardia-induced cardiomyopathy is expressed by cardiac dilatation and heart failure resulted from long-term tachycardia or tachyarrhythmia. Its pathogenic mechanism is not clear, which is possibly related to hemodynamic changes, cardiac mechanical remodeling and myocardial electrical remodeling, etc. Reversibility is a significant clinical feature of the disease, that is, the impaired heart function recovers after tachyarrhythmia is controlled. Drugs and radiofrequency catheter ablation can treat tachycardia-induced cardiomyopathy effectively.
		2015 Vol. 24 (1): 18-21 [Abstract] ( 1130 ) [HTML 1KB] [ PDF 931KB] ( 1571 )

	22	Wolff-Parkinson-White syndromeinduced cardiomyopathy
		LUO Ya-Xiong, GONG Xiao-Peng, WANG Fu-Jun
		Wolff-Parkinson-White (WPW) syndrome can induce dilated cardiomyopathy. Previously, it was frequently reported that WPW syndrome complicating recurrent or persistent tachyarrhythmias can develop into dilated cardiomyopathy, that is, tachycardiainduced cardiomyopathy. In addition, WPW syndrome may be accompanied with hypertrophic cardiomyopathy. WPW syndrome can cause another type of dilated cardiomyopathy, WPW syndromeinduced cardiomyopathy, also known as WolffParkinsonmediated cardiomyopathy. It is due to the affected electrical mechanical properties of synchronous ventricular excitation and contraction, leading to influence the mechanical function of heart and induce ventricular remodeling. Besides the diagnostic criteria for dilated cardiomyopathy, WPW syndromeinduced cardiomyopathy still has the following two characteristics: (i) Asymptomatic WPW syndrome, that is, no medical history of recurrent or persistent attack of tachyarrhythmia clinically; (ii) Twelve lead surface ECG indicates right sided manifest WPW. Radiofrequency ablation is safe and effective in treating the disease.
		2015 Vol. 24 (1): 22-23,27 [Abstract] ( 1268 ) [HTML 1KB] [ PDF 943KB] ( 1834 )

	24	Premature ventricular contraction-induced cardiomyopathy
		WANG Fu-Jun, LIU Hong-Xia, LUO Ya-Xiong
		Long-term frequent premature ventricular contraction(PVC)(especially＞10 000 times/ 24 h) can cause cardiomyopathy, the clinical features of which are similar to those of dilated cardiomyopathy, and myocardial lesions can be reversed after the elimination of PVC. The disease is called PVC-induced cardiomyopathy. Its pathogenesis is not clear, which is possibly related to mechanical heart contraction and asynchronism of electrical excitement resulting in overloaded ventricle, activated neurohumoral mechanism, reduced effective heart pump output, weakened diastolic function and other factors. The load of PVC proves to be the most important factor of cardiomyopathy. At present, diagnostic methods for PVC-induced cardiomyopathy are mostly retrospective diagnosis. If myocardial lesions can be reversed after the elimination of PVC, the diagnosis for PVC-induced cardiomyopathy can be confirmed. Appropriate medication or radiofrequency catheter ablation can reduce and even eliminate PVC, and therefore improve heart function.
		2015 Vol. 24 (1): 24-27 [Abstract] ( 1574 ) [HTML 1KB] [ PDF 935KB] ( 1616 )

	28	Left bundle branch block-induced cardiomyopathy
		XIANG Zhi-Qing, TIAN Jun-Hua, WANG Fu-Jun
		Long-term true left bundle branch block can cause left ventricular dilatation, progressive decrease of cardiac function, and further develop into cardiomyopathy complicated by cardiac functional insufficiency. Its pathogenesis is not clear, which is possibly related to the synchronization loss of electrical and mechanical activities caused by left bundle branch block. The diagnostic method of the disease is consistent with that of other acquired cardiomyopathy, the highlight of which is to identify true left bundle branch block. By cardiac resynchronization therapy, left bundle branch block-induced cardiomyopathy can be reversed effectively.
		2015 Vol. 24 (1): 28-29 [Abstract] ( 887 ) [HTML 1KB] [ PDF 914KB] ( 1746 )

	30	Tachycardia-induced atrial cardiomyopathy
		SHI Xiang, WU Xiao-Qin, WANG Fu-Jun
		Recurrent atrial tachyarrhythmia or atrial fibrillation can induce various remodeling such as atrial metabolic remodeling, electrical remodeling, contraction remodeling and anatomical remodeling, resulting in tachycardia-induced atrial cardiomyopathy. Timely cardioversion therapy can reverse atrial remodeling and recover cardiac function.
		2015 Vol. 24 (1): 30-31 [Abstract] ( 1322 ) [HTML 1KB] [ PDF 910KB] ( 1612 )

	32	Analysis on 1 992 telemonitoring ECGs of elderly residents living in aged welfare organizations
		GU Ju-Kang, CHEN Shu-Hua, WU Di, WANG Dong-Mei
		Objective To know the electrocardiogram(ECG) information of elderly residents in aged welfare organizations, in order to provide a reference for preventing and treating geriatric diseases. Methods By 12 lead CTM 8000 ECG telemonitor, 1 992 cases of ECG data were collected from the elderly residents over 60 years old in four aged welfare organizations of Shanghai, during seven months from April 1 to October 31 in 2014. Results Among 1 992 cases of ECGs, there were 376(18.9%) normal or basically normal cases while abnormalities were found in 1 616 ECGs, accounting for 81.1%, significantly higher than the general abnormality detection rate in ECG telemonitoring both at home and abroad. Abnormal ECGs mainly included 185 cases(9.3%) of atrial fibrillation, 179 cases(9.0%) of atrial premature beats, 117 cases(5.8%) of ventricular premature beats, and 1 135 other abnormal ECGs(including acute myocardial infarction), accounting for 57.0%. Among other abnormal ECGs, ischemic changes with ST segment elevation were found in 12 cases. Additionally, the monitoring results indicated atrial fibrillation was a common risk factor of cardiovascular diseases for elderly residents in aged welfare organizations.Conclusion Twelve lead ECG telemonitoring system can capture abnormal ECG information of elderly residents in aged welfare organizations in time, especially performs well in the prevention and treatment of atrial fibrillation or acute ischemic diseases, and remote disposal of severe cases, etc. Its great advantages help patients with early diagnosis and timely therapy.
		2015 Vol. 24 (1): 32-33,39 [Abstract] ( 1031 ) [HTML 1KB] [ PDF 981KB] ( 1649 )

	34	Clinical progress on remote realtime multiparameter monitoring technique: both domestically and abroad
		CHEN Qing-Ping
		To strengthen national health care and reduce the disability and mortality of chronic diseases such as cardiovascular disease, remote realtime multiparameter monitoring technique has been widely applied in monitoring arrhythmia, blood pressure, blood sugar, and blood sugar, which makes up for the disadvantages of routine electrocardiogram, ambulatory electrocardiography, casual blood pressure,blood sugar and other conventional means of detection. Especially for patients with chronic diseases, the elderly and subhealthy people, remote realtime multiparameter monitoring can capture and transmit abnormal physiological data at the first time, help clinicians make diagnosis and treatment timely, and therefore decrease prehospital mortality effectively. This paper reviews the development status and clinical applications of remote multiparameter monitoring technique both domestically and abroad. The development of the technique in the future is also prospected.
		2015 Vol. 24 (1): 34-39 [Abstract] ( 1234 ) [HTML 1KB] [ PDF 1583KB] ( 2128 )

	40	Design and application of future global unlimited cellular big data network system of ECG
		LIU Li, LIU Chao-Hui, ZHAO Wen-Jiao, LU Yong-Hong
		Based on the conceived integrated framework and module technical proposals of global unlimited cellular big data network system of vital sign instruments, this paper introduces digitalized ECG network system aiming to realize online teletransmission of ECG information among various countries and regions globally, and to construct a more refined ECG diagnosis platform in, outside and pre hospital. The digitalized ECG network system provides detailed ECG diagnosis reports in time for clinicians, shortens treatment time for patients, and especially earns rescue time for severe cases. Further, based on the global unlimited cellular big data network system of ECG, global expert consultation center can be established, in order to integrate medical resources globally, promote seamless academic exchanges on Electrocardiology both at home and abroad, and abridge the gaps of diagnosis and treatment levels of ECG among different countries and regions.
		2015 Vol. 24 (1): 40-43 [Abstract] ( 1333 ) [HTML 1KB] [ PDF 1589KB] ( 2319 )

	44	ECG scatterplot in the rapid diagnosis of nodal escape and nodal escape rhythm
		JING Yong-Ming, HUANG Yan
		At the occurrence of second degree(or higher) atrioventricular block in the atrioventricular junctional area, RR long interval which appears intermittently or continuously was usually eliminated by nodal escape or nodal escape rhythm. It is actually a kind of self-protection mechanism of human beings. The appearance of nodal escape or nodal escape rhythm complicates the ECG of second degree atrioventricular block which is originally relatively complex while 24-hour ambulatory electrocardiography includes all possible combinations of various long and short cycles. However, ECG scatterplot in analysis software clearly manifests two significant electrophysiological characteristics of nodal escape and nodal escape rhythm from different angles, that is, escape cycle is relatively fixed and escape rhythm readjusts at any time. This paper summarizes three scatterplot features of escape rhythm and its analysis method, based on explanation of practical cases. Characteristic ECG scatterplot makes it possible to recognize nodal escape and nodal escape rhythm quickly and accurately.
		2015 Vol. 24 (1): 44-47,69 [Abstract] ( 1217 ) [HTML 1KB] [ PDF 6093KB] ( 1550 )

	48	Application of Lorenz scatterplot in identifying the originating site of short coupling interval ventricular premature beats
		Zheng-Wen-Kai, LIU Lin-Yong, KANG Hong, XU Zhi-Yong
		Objective To explore the correlation between short coupling interval ventricular premature beats(PVBs) and ventricular anatomical position. Methods Lorenz plot was utilized in finding the points representing the shortest coupling interval among the PVBs point set, and the originating site of PVBs was identified by reversal technique. The shortest coupling intervals of 401 cases with single-sourced PVBs and 93 cases with multifocal PVBs were measured and statistically analyzed. Based on the analysis, the regions were specified where the short coupling interval PVBs was prone to occur. Results PVBs originating at the apex of left and right ventricle had the shortest coupling intervals, whatever among singlesourced or multifocal PVBs. There was no statistically significant difference in the shortest coupling interval between left and right ventricular apex originated PVBs(P＞0.05), however, if compared with those of PVBs originating from other sites, the differences were statistically significant(P＜0.05). Conclusion It is possibly related to the structure and function of heart apex that the shortest coupling interval is found in PVBs originating at the apex of left and right ventricle. Meanwhile, it requires further study on large sample to decide whether PVBs originating at the above sites can induce some kinds of malignant ventricular arrhythmias.
		2015 Vol. 24 (1): 48-53 [Abstract] ( 1468 ) [HTML 1KB] [ PDF 6989KB] ( 850 )

	54	Ventricular electrical storm after acute myocardial infarction: clinical observation on 8 cases
		TANG Min
		Objective By analyzing the clinical data of 8 cases with acute myocardial infarction(AMI) complicating ventricular electrical storm, to explore the clinical characteristics and treatment of the disease. Methods Various clinical features of the 8 patients such as sex, age, site of myocardial infarction, time interval between the onset of AMI and the attack of ventricular electrical storm, duration of ventricular electrical storm, efficacy and prognosis of treatment were all analyzed and summarized. Results Among the 8 patients, 6 cases (75%) were males, and 4 cases(50%) were 70-79 years old. Ventricular electrical storm attacked within 6 hours after AMI in 5 cases(62.5%). Inferior myocardial infarction occurred in 5 cases(62.5%). The average duration of ventricular electrical storm was (107.4±110.9) min. There were 2 cases treated by amiodarone alone, 3 cases by amiodarone plus magnesium sulfate, one case by amiodarone plus lidocaine, and when amiodarone therapy proved to be of no effect, esmolol immediately terminated ventricular electrical storm in 2 cases. Two cases died, and 6 cases were successfully rescued, with a survival rate of 75%. Conclusion Ventricular electrical storm are frequently diagnosed among elderly males, which usually attacks within 6 hours after AMI. Right coronary artery lesions are more likely to induce ventricular electrical storm. Early cardioversion, defibrillation and reasonable applications of antiarrhythmic drugs including β-blockers are extremely important. It proves to be safe and effective to give intravenous thrombolytic therapy and open criminal vessel during a rescue.
		2015 Vol. 24 (1): 54-57,61 [Abstract] ( 1149 ) [HTML 1KB] [ PDF 1039KB] ( 1758 )

	58	Comparative analysis on 12 lead ambulatory electrocardiography and routine electrocardiogram in diagnosing early repolarization syndrome
		WANG Rong
		Objective To compare the detection rates of early repolarization syndrome(ERS) by 12 lead ambulatory electrocardiography(AECG) and routine electrocardiogram(ECG), and to reveal the former's diagnostic value. Methods Retrospective analysis was made on 3 967 cases of 12 lead AECG data. The above two electrocardiographic examination methods were utilized in screening ERS, strictly according to diagnostic criteria. The differences of ST segment and T wave in two different lead connection methods were comparatively analyzed. Results By 12 lead AECG, 81 ERS patients were screened out of the enrolled candidates, with a detection rate of 2.04%. There were 73 males(90.12%) and 8 females(9.88%), and the difference between the proportion of males and females was statistically significant(P＜0.01). The detection rate of ERS in 31-45 years old age group was higher than that in other age groups. However, only 9 ERS patients were screened out by routine 12 lead ECG(detection rate 0.23%). Conclusion The detection rate of ERS by 12 lead AECG is higher than that by routine 12 lead ECG. Twelve lead AECG can reflect ECG features of the disease better, especially the relationship between characteristic changes of ST-T segment and patients' heart rate as well as rational symptom. Therefore, this method is clinically valuable in diagnosing ERS.
		2015 Vol. 24 (1): 58-61 [Abstract] ( 1473 ) [HTML 1KB] [ PDF 937KB] ( 2201 )

	62	Research on ambulatory electrocardiography of long RP tachycardia
		ZHANG Lin, LI Bo, NA Zhi-Ying, YIN Lin, WANG Yue, FENG Xia
		Objective To study the manifestations of long RP tachycardia on ambulatory electrocardiography(AECG) and its differential diagnostic basis. Methods By 12channel AECG recorder, 35 patients with long RP tachycardia were monitored. At the attack of tachycardia, we made comparative analysis on its states of induction and termination, duration, frequency, P-wave polarity, clinical characteristics, etc. Results The enrolled 35 patients were divided into 3 groups: separately with persistent atrioventricular reentrant tachycardia(PAVRT), atrial tachycardia(AT), and fastslow atrioventricular nodal reentrant tachycardia(F-S-AVNRT). Among the 3 groups, P waves were inverted in Ⅱ, Ⅲ and aVF leads, aVR leads were upright, and RP intervals were all longer than PR intervals, at the onset of tachycardia. The attack of 6 cases of PAVRT was endless, tachycardia accounting for 32.8%—50.0% in the total heartbeats during 24 hours, with an attacking frequency ranging from 110 times/min to 160 times/min, which was induced by premature ventricular beats. AT was induced by atrial premature beats in 15 cases, with the number of onset episodes ranging from 1 to 186, and onset frequency 107—150 times/min. F-S-AVNRT in 2 cases was induced by atrial premature beats accompanied with prolonged PR intervals, with an attack frequency ranging from 127 times/min to 182 times/min. Atrial flutter complicating 2 ∶1 atrioventricular conduction in 12 cases was induced by atrial premature beats; Its onset ventricular rate ranged from 120 times/min to 165 times/min, and the ventricular rate reached 150 times/min when the conditions of the Bix law was met. Conclusion AECG monitoring plays a significant role in identifying the states of induction and termination, duration, and frequency during the onset of long RP tachycardia. It helps to diagnose the disease.
		2015 Vol. 24 (1): 62-65 [Abstract] ( 1385 ) [HTML 1KB] [ PDF 3543KB] ( 1590 )

	66
		HE Fang-Tian, LU Hai-Yan, LV Tan

		2015 Vol. 24 (1): 66-69 [Abstract] ( 1055 ) [HTML 1KB] [ PDF 4881KB] ( 2105 )

	70	Construction and application of ECG technique examination database system in “5+3” training mode of medical students
		ZHANG Yong-Jun, YANG Hao, WANG Yin-Ze, XU Shang-Yin, LU Qi-Le, CHENG Tao-Ling
		To adapt the present “5+3” mainstream training mode of medical students in China, improve teaching effect of ECG technique, and accelerate the standardized process of ECG manipulative skills, this paper mainly discusses the procedures of ECG examination database construction and its application in details, taking the database system established by our hospital as an example. The built examination database improved ECG skill test, elevated ECG educational quality, and therefore advanced the level of scientific management of ECG teaching.
		2015 Vol. 24 (1): 70-72 [Abstract] ( 1242 ) [HTML 1KB] [ PDF 983KB] ( 1681 )

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