JOURNAL OF PRACTICAL ELECTROCARDIOLOGY

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JOURNAL OF PRACTICAL ELECTROCARDIOLOGY

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JOURNAL OF PRACTICAL ELECTROCARDIOLOGY

	2015 Vol.24 Issue.4 Published 2015-08-28

Article

	229	A practical approach to atypical atrial flutter
		Jeffrey Munro, Win-Kuang Shen
		Atrial flutter is a heterogeneous group of re-entrant atrial arrhythmias including typical atrial flutter where the cavo-tricuspid isthmus is a critical zone of conduction and atypical atrial flutter in which the re-entrant circuit can exist in the right or left atrium associated with scar and a slow zone of conduction. The prevalence of atypical atrial flutter is increasing as the number of cardiac surgery and catheter based ablations of atrial fibrillation is more widespread. Typical atrial flutter ablation typically involves a linear ablation along the cavo-tricuspid isthmus as opposed to atypical atrial flutter usually requiring an integrated approach of electroanatomical voltage mapping and activation mapping in a computer based 3D mapping system as well as entrainment techniques for determining critical zones of conduction. In this article we present a case of atypical atrial flutter that we have employed these tools to determine the components of an atypical atrial flutter circuit,specifically the critical zone of conduction which was targeted with radiofrequency ablation for termination of atypical- atrial flutter in a patient with a prior ablation for atrial fibrillation.
		2015 Vol. 24 (4): 229-244 [Abstract] ( 1560 ) [HTML 1KB] [ PDF 4414KB] ( 1339 )

	244


		2015 Vol. 24 (4): 244-244 [Abstract] ( 731 ) [HTML 1KB] [ PDF 812KB] ( 1470 )

	245	Brugada phenocopy: emergence of a new clinical entity
		Byron H Gottschalk, Daniel D Anselm, Adrian Baranchuk
		Brugada phenocopies (BrP) are clinical entities that present with ECG patterns identical to true Brugada syndrome (BrS) but are induced by various clinical conditions. They are characterized by type 1 or type 2 Brugada ECG patterns in precordial leads (V1-V3) that present during an associated underlying condition. Upon resolution of the underlying condition, these ECG patterns normalize. In this study, we reviewed the classification of BrP, methods for differentiating BrP from BrS, and recently discussed etiologies of BrP. In addition, we provided an update on the international online registry for BrP and discussed future directions in BrP research.
		2015 Vol. 24 (4): 245-255 [Abstract] ( 1793 ) [HTML 1KB] [ PDF 1393KB] ( 1466 )

	256	Clinical value of surface electrocardiogram in diagnosing coronary atherosclerotic cardio pathy
		刘红彬，张晓华，张志刚，刘志红
		Selective coronary angiography is regarded as a gold standard for the diagnosis of coronary atherosclerotic cardiopathy(coronary heart disease), but not all the hospitals are qualified for the testing, and additionally, it is risky in some extent and relatively expensive. At present, non-invasive-testing methods for diagnosis of coronary heart disease include electrocardiogram(ECG), ambulatory electrocardiography, and treadmill exercise test, especially surface ECG which is convenient, rapid and low cost, and shows characteristic changes in cases of stable angina pectoris, acute coronary syndrome, etc. At the occurrence of acute myocardial infarction, culprit vessels position can be prejudged through ECG changes, and therefore surface ECG is vital in diagnosing coronary heart disease.
		2015 Vol. 24 (4): 256-260 [Abstract] ( 1638 ) [HTML 1KB] [ PDF 861KB] ( 7041 )

	261	Clinical values of repolarization abnormal ECG manifestations for diagnosis and prognosis of coronary heart disease
		苏冠丽,刘刚,郑明奇,李斌
		As a practical tool, electrocardiogram(ECG) is widely applied in the diagnosis and prognosis evaluation of coronary heart disease, especially ECG with abnormal myocardial repolarization. The repolarization abnormalities mainly manifest in the changes of ST segments, T waves, and QT durations. This paper discusses ST segment, T wave, and QT duration in details, and summarizes those indices clinical values for the diagnosis and prognosis evaluation of coronary heart disease, with the boundedness also analysed. It points in the right direction for the clinical application of those indices. U wave has higher specificity in the diagnosis of ischemic heart disease, however it has been focused by relatively few clinical studies. In addition, T wave electrical alternans and T peak end interval(Tp-Te) are also indicators for myocardial repolarization. However, the two indices were not referred in details in this paper since their application is rarely seen clinically and they mainly associate with malignant arrhythmia.
		2015 Vol. 24 (4): 261-266 [Abstract] ( 1519 ) [HTML 1KB] [ PDF 881KB] ( 5498 )

	266


		2015 Vol. 24 (4): 266-266 [Abstract] ( 875 ) [HTML 1KB] [ PDF 806KB] ( 1444 )

	267	ECG differential diagnosis of myocardial infarction
		侯爱军,朱琳
		Electrocardiogram(ECG) is a diagnostic method frequently and easily applied in making preliminary assessment, risk stratification at early phase, screening, and treatment instruction for patients with pectoralgia. ECG changes serve as an important reference for the diagnosis of acute myocardial infarction, which plays an indispensable role in determining the nature of myocardial infarction, judging the diseased region, and evaluating the severity of the disease. However, there lie limits in sensitivity and specificity when ECG is utilized in diagnosing myocardial infarction. Part of myocardial infarction ECGs manifest no change or atypical changes while ECG changes exactly similar to those of myocardial infarction are found in ECGs of healthy people or cases with some other diseases. Therefore, it requires comprehensive analysis in ECG diagnosis of myocardial infarction. This paper briefly depicts ECG changes complicating common diseases, in order not to be confused with myocardial infarction ECG changes.
		2015 Vol. 24 (4): 267-270 [Abstract] ( 1842 ) [HTML 1KB] [ PDF 843KB] ( 2817 )

	271	The influence of slowing breathing frequency on heart rate variability in patients with acute myocardial infarction
		刘俊敏,刘仁光,沈仲元
		Objective To observe the changes of heart rate variability(HRV) in patients with acute myocardial infarction(AMI), and to analyze the influence of slowing breathing frequency on HRV of AMI patients. [WTHZ]Methods[WT]Experiment was carried out in two groups, with 31 cases in AMI group, and 34 in control group. All the enrolled patients underwent 24 hour monitoring of respiration and electrocardiogram. The breathing frequency of AMI group was regulated at 16 times/min and 8 times/min(slowing the breathing frequency) separately for 5 minutes. The influence of AMI on HRV was observed as well as the slowing of breathing frequency on HRV time domain, respiratory peak, and frequency domain analysis. The influence of respiratory peak shift on frequency domain analysis was adjusted. [WTHZ]Results[WT](i) In AMI group, SDNN and SDANN were lower than those of control group(P＜0.01), and so were SDNNin and rMSSD(P＜0.05), both with statistically significant differences. The proportion among AMI group with SDNN shorter than 100 ms was significantly higher than that in control group(P＜0.01), with statistically significant difference. (ii) With the slowing of breathing frequency, SDNN increased(P＞0.05), and rMSSD also increased(P＜0.05); respiratory peak shifted left to LF segment(P＜0.01) while routine frequency domain indices of LF and LF/HF both increased(P＜0.01), and HF decreased(P＜0.01). The slowing of breathing frequency resulted in the left shift of respiratory peak. After its impact on frequency domain analysis was corrected, low frequency component(LFa) decreased(P＜0.05), high frequency component(HFa) increased(P＜0.01), and the ratio(LFa/HFa) decreased(P＜0.01). [WTHZ]Conclusion[WT]Twenty-four hour HRV time domain analysis on AMI patients indicates that AMI can reduce the function of vagus nerve. Short duration analysis of frequency and time domain on AMI patients suggests that slowing of breathing frequency causes sympathetic vagal balance toward the vagus nerve and its influence on the left shift of respiratory peak should be excluded in HRV frequency domain analysis.
		2015 Vol. 24 (4): 271-275 [Abstract] ( 1386 ) [HTML 1KB] [ PDF 1106KB] ( 2294 )

	276	Observation on ambulatory electrocardiography in 1 635 elderly and pre-elderly patients with arrhythmia and myocardial ischemia
		陈晓华,王瑞,赵玥,张艳
		Objective To explore the characteristics of ambulatory electrocardiography(AECG) in elderly and pre-elderly patients with arrhythmia and myocardial ischemia.Methods The AECG examination results of 1 635 elderly and pre-elderly patients with cardiac symptoms or suspicious of heart diseases were analysed and compared with those of 952 middle aged and young people contemporarily in our hospital.Results The incidences of various arrhythmias increased with age among elderly and pre-elderly patients while ischemic changes of ST segment were identified in some asymptomatic cases.Conclusion AECG monitoring can screen out high risk group of arrhythmia and myocardial ischemia, especially superior to routine electrocardiogram in diagnosing arrhythmia among elderly patients. For elderly and pre-elderly cases with lower reactivity body, AECG is an indispensable examination method.
		2015 Vol. 24 (4): 276-278 [Abstract] ( 1184 ) [HTML 1KB] [ PDF 858KB] ( 1713 )

	279	Study on the relationship between heart rate variability and ambulatory blood pressure variability in isolated systolic hypertensives
		于迎根,彭颖秀,史咏秋
		Objective To investigate the relationship between heart rate variability(HRV) and ambulatory blood pressure variability(BPV) in patients with isolated systolic hypertension(ISH), and to observe the relevance of autonomic nerve functional lesion to ventricular hypertrophy for essental hypertensives. Methods Fifty-seven patients with ISH were enrolled as observation group(including two subgroups:hypertrophy group and non-hypertrophy group) while another 36 individuals with normal blood pressure and without left ventricular hypertrophy as control group. The two groups underwent 24-hour ambulatory electrocardiography(Holter) and 24-hour ambulatory blood pressure monitoring(ABPM) simultaneously, with related HRV and BPV indices recorded.Results The change trends of HRV and BPV were found to be opposite between observation group and control group. That was to say, HRV time domain indices of SDNN, rMSSD and pNN50% in observation group were significantly lower than those of control group while 24 h SSD was significantly higher, both with statistically significant differences(P＜0.01). Compared with that of control group, SBP value of hypertrophy group was higher in each time period, while there was no statistically significant difference between DBP value of the two groups. In addition, the incidence of 24-hour ventricular premature beat among hypertrophy group was higher than that in control group, with statistically significant difference(P＜0.01).Conclusion The relevant changes of HRV and BPV in patients with isolated systolic hypertension indicate the important role autonomic nerve functional lesion plays in the development of hypertensive left ventricular hypertrophy.
		2015 Vol. 24 (4): 279-282 [Abstract] ( 1451 ) [HTML 1KB] [ PDF 842KB] ( 1655 )

	283	Study on early warning of deceleration capacity of rate for acute myocardial infarction patients
		李厚荣,何娟,杜国伟,殷波,向娟,金海燕,李潇华,余华,何艳萍
		Objective To explore the significance of deceleration capacity of rate(DC) in early warning of acute myocardial infarction(AMI).Methods In our study, 200 patients were enrolled in AMI group who were attacked by AMI two weeks ago at most and restored sinus rhythm afterwards. Another 200 cases without AMI were divided into non-AMI group. All the candidates underwent 24-hour ambulatory electrocardiography. Their values of DC and acceleration capacity of rate(AC) were recorded and made early warning analysis. Results In AMI group, single vessel disease was found in 52 cases, two vessel disease in 98 and triple vessel disease in 50 while the numbers were 98, 68, and 34, respectively in non AMI group. For patients in AMI group, the mortality in one year was as follows: 2.00% if DC≥4.5 ms; 7.50% if DC was 2.6-4.4 ms; 10.05% if DC≤2.5 m, with statistically significant differences(P＜0.01). No death was reported in non AMI group,with variation of DC values. AC≤－7.0 ms,and no death was reported except for a mortality in one year of 1.00% in AMI group. Conclusion DC determination can quantitively analyze and measure the intensity of vagus nerve effect all alone, which proves to be significantly practical in screening and making early warning of AMI patients at high risk from sudden death.
		2015 Vol. 24 (4): 283-286 [Abstract] ( 1336 ) [HTML 1KB] [ PDF 872KB] ( 1675 )

	287	New advance of deceleration capacity of rate and heart rate deceleration runs
		刘衍恭,田立,郑明奇
		The autonomic nervous system regulates physiological activities of cardiovascular system, and dysfunction of autonomic nerve will result in the occurrence and development of many diseases. Testing of deceleration capacity of rate(DC) and heart rate deceleration runs(DRs) is easy and simple to handle, stable and reliable, which serves as an ideal method for monitoring autonomic function. With combination of the two indices and others, the efficiency of risk stratification and prognosis evaluation can be significantly improved in patients with myocardial infarction, atrial fibrillation, and heart valve disease, making early warning for high risk group. Additionally, DC is also related to cardiovascular diseases including cardiomyopathy, hypertension, and heart failure, however, the specific clinical significance still needs further research. The electrocardiographic testing of DC and DRs proves to have great clinical value and development potential, which is worthy of being prevalent clinically and investigated further.
		2015 Vol. 24 (4): 287-292 [Abstract] ( 2819 ) [HTML 1KB] [ PDF 883KB] ( 2583 )

	293
		李晓燕,张常莹,郁志明,李嘉萍,李库林,王如兴

		2015 Vol. 24 (4): 293-294 [Abstract] ( 1232 ) [HTML 1KB] [ PDF 1013KB] ( 2012 )

	295
		陆静瑜,黄金康

		2015 Vol. 24 (4): 295-296 [Abstract] ( 1171 ) [HTML 1KB] [ PDF 3853KB] ( 1648 )

	296


		2015 Vol. 24 (4): 296-297 [Abstract] ( 749 ) [HTML 1KB] [ PDF 1162KB] ( 1469 )

	298
		肖爱英,祝丽萍

		2015 Vol. 24 (4): 298-299 [Abstract] ( 1090 ) [HTML 1KB] [ PDF 1389KB] ( 1893 )

	300
		黄瑞燕

		2015 Vol. 24 (4): 300-301 [Abstract] ( 1135 ) [HTML 1KB] [ PDF 1459KB] ( 1925 )

	302
		张华琴,吴岳平

		2015 Vol. 24 (4): 302-304 [Abstract] ( 1311 ) [HTML 1KB] [ PDF 4057KB] ( 2211 )

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