JOURNAL OF PRACTICAL ELECTROCARDIOLOGY

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JOURNAL OF PRACTICAL ELECTROCARDIOLOGY

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JOURNAL OF PRACTICAL ELECTROCARDIOLOGY

	2015 Vol.24 Issue.6 Published 2015-12-28

Article

	381	Diagnosis and early warning electrocardiogram reevaluation in sudden cardiac death related disease
		ZHENG Wei-Ping, CHEN Feng, LI Feng, WANG Wu-Yi, LIN Kai-Yang, LIN Chun-Jin
		Sudden cardiac death (SCD) is the leading cause of death from cardiovascular disease. SCDrelated diseases have a very high mortality rate in hospital and prehospital emergency rescue, so early diagnosis and prevention is the key measure of treating such diseases.Since the advent of a hundred years ,ECG has become an independent knowledge and makes its progress with the development medicine. Electrocardiogram plays an important role in the diagnosis and early warning of SCD diseases.This article describes the development and changes in the electrocardiogram science in the diagnosis and early warning of SCD diseases.
		2015 Vol. 24 (6): 381-390 [Abstract] ( 1245 ) [HTML 1KB] [ PDF 7495KB] ( 1379 )

	390


		2015 Vol. 24 (6): 390-390 [Abstract] ( 630 ) [HTML 1KB] [ PDF 768KB] ( 1192 )

	391	Application and Development of antiarrhythmic drugs in sudden cardiac death related diseases
		LIN Chun-Jin, ZHENG Wei-Ping, LI Feng, JIANG Yun, XIAO Jian-Min, LIN Kai-Yang
		Sudden cardiac death (SCD) is a serious complication of cardiovascular disease.Primary inherited arrhythmia syndrome and acute coronary syndrome are the two major causes of SCD .Antiarrhythmic drugs have been used in clinical application for nearly a hundred years. Both in the rescue and subsequent treatment and prevention of SCD related diseases,the antiarrhythmic drugs are still the basic treatment measures. With the development of evidencebased medicine, antiarrhythmic drugs have been changed in indications and instructions. Meanwhile research and development and application of new antiarrhythmic drugs in this area have brought new directions and focuses. This article describes the application and progress of the antiarrhythmic drugs for the SCD diseases.
		2015 Vol. 24 (6): 391-397 [Abstract] ( 1149 ) [HTML 1KB] [ PDF 925KB] ( 1817 )

	397


		2015 Vol. 24 (6): 397-397 [Abstract] ( 578 ) [HTML 1KB] [ PDF 775KB] ( 1040 )

	398	The relationship between genetic test of sudden cardiac death related diseases and electrocardiology
		ZHENG Wei-Ping, CHEN Hai-Feng, CHEN Feng, LI Feng, XIAO Jian-Min, LIN Kai-Yang
		Genetic testing is the fourth generation laboratory biological detection technology after cytologic testing, zymologic testing and immunological testing. Unlike the other three generations of biological testing in a laboratory, genetic testing can be used in early diagnosis of a disease before any of the clinical symptoms occur. This technology provides favorable conditions for the prevention and treatment of clinical diseases especially fatal diseases. Genetic testing is also a premise for gene therapy in the future. The main causes pathogens of youth SCD are heritable cardiac channelopathies and heritable cardiomyopathies. Genetic testing is of significantly medical value for diagnosis, prevention and treatment of SCDrelated disease. However, more attention needs to be paid to the premises and conditions of genetic testing.This paper provides brief introduction to the development and application of genetic testing on SCDrelated diseases.
		2015 Vol. 24 (6): 398-402 [Abstract] ( 1169 ) [HTML 1KB] [ PDF 775KB] ( 1153 )

	403	The intrinsic relationship between Lorenz-RR scatterplot and difference scatterplot
		JING Yong-Ming, XIANG Jin-Tao, HUANG Yan
		Objective To discuss the intrinsic relationship between Lorenz-RR scatterplot and difference scatterplot, and to interpret reports of the two types of scatterplots correctly showed simultaneously in ambulatory electrocardiography(AECG). Methods The mathematical models of Lorenz-RR scatterplot and difference scatterplot were made separately with dynamic drawing and trajectory tracking functions of “Geometer’s Sketchpad”. The relationship between theoretical models and actual scatterplots was analysed when combined with practical cases.Results The theoretical models and the actual scatterplots almost overlapped. Conclusion The difference scatterplot is drawn by the vector difference within the Lorenz-RR scatterplot, which provides the rhythm information of AECG further. The two types of scatterplots are mutually complementary and make confirmation for each other.
		2015 Vol. 24 (6): 403-407 [Abstract] ( 1252 ) [HTML 1KB] [ PDF 5011KB] ( 2233 )

	408	Clinical application of remote three dimensional ECG scatterplot
		LIU Li, ZENG Jian-Ping, GU Ju-Kang, JIN Deng-Nan
		Objective To discuss the diagnostic value of remote monitoring technology combined with three dimensional ECG scatterplot technology forarrhythmia patients. Methods The 24-hour ambulatory electrocardiography(AECG) data(mass ECG data) of 32 arrhythmia patients were transmitted by remote network. With the Lorenz scatterplot analysis method of nonlinear theory, the intuitive geometric model was combined with mathematical model by the processing of computer, and the analysis software was translated into three dimensional model, before the occurrence time, duration, and frequency of arrhythmia could be extracted from longterm ECG data. Results Three dimensional colored ECG scatterplot was brightly colored, and possessed strong stereoscopic feel, which not only displayed the types and severity of arrhythmia intuitively, but also revealed its occurrence time, duration, and frequency. Conclusion Three dimensional ECG scatterplot is a new method of analyzing AECG quickly and accurately, which possesses both of the advantages of t -RR scatterplot and Lorenz scatterplot. Therefore, it is applicable to the clinical diagnosis of arrhythmia.
		2015 Vol. 24 (6): 408-412 [Abstract] ( 1180 ) [HTML 1KB] [ PDF 7149KB] ( 1282 )

	413	ECG scatterplot in rapid diagnosis of sinus rhythm complicating atrial parasystolic rhythm and frequent premature ventricular contraction
		JING Yong-Ming, QIU Hui-Min, XIANG Jin-Tao, HUANG Yan
		The ambulatory electrocardiography(AECG) of sinus rhythm complicating atrial parasystolic rhythm and frequent premature ventricular contraction is relatively complex. It is almost impossible to analyze it accurately and quickly without the help of ECG scatterplot. The tRR scatterplot can show the occurring time and duration of arrhythmia; Lorenz scatterplot can reflect electrophysiological characteristics of dominant rhythm and auxiliary rhythm respectively; difference scatterplot can clearly reveal the overlapping and illegible rhythm information in Lorenz scatterplot. The three kinds of scatterplots make complementation and confirmation mutually, depicting the competition and interfering process of sinus rhythm complicating atrial parasystolic rhythm and frequent premature ventricular contraction by multiple perspectives. It is helpful to analyze AECG accurately and quickly,and comprehend the electrophysiological significance of arrhythmia further, if clinicians can master the simple and effective analysis method of ECG scatterplot.
		2015 Vol. 24 (6): 413-418 [Abstract] ( 1534 ) [HTML 1KB] [ PDF 24818KB] ( 1049 )

	418
		LIU Li

		2015 Vol. 24 (6): 418-418 [Abstract] ( 618 ) [HTML 1KB] [ PDF 2122KB] ( 1198 )

	419	The electrocardiogram characteristics of left circumflex artery as infarction related artery in acute myocardial infarction
		GUO Chen-Xian, SHEN Zhi-Jie, WANG Xiao-Long
		Objective To analyze the electrocardiogram characteristics of left circumflex artery as infarction related artery(IRA) in acute myocardialinfarction. Methods 94 cases of acute myocardial infarction with infarction related artery of left circumflex artery(LCX) and right coronary artery (RCA) patients were collected from January 2010 to July 2013 in Shuguang hospital affiliated to Shanghai university of traditional Chinese medicine. The emergency electrocardiogram characteristics of patients were retrospectively analyzed with ST segment changes in lead Ⅰ, aVL; lead of inferior 8wall (Ⅱ,Ⅲ,[LM]aVF) and chest leads. Comparison of STⅡand STⅢwas measured under the condition when IRA was LCX or RCA with elevated ST segment in theinferior wall. Results Among the full set of patients with acute myocardial infarction, IRA with LCX counted for 30 cases while IRA with RCA, 64 cases. (i) Correlation analysis of lead Ⅰ, aVL with IRA: Lead Ⅰ depression in IRALCX, 3 cases; nondepression 27 cases. Lead Ⅰ depression in IRARCA, 22 cases; non-depression 42 cases with statistically significance in two groups (P=0.013).Lead aVL depression in IRALCX, 3cases; nondepression 27 cases.Lead aVL depression in IRARCA, 26 cases; nondepression 38 cases with statistically significance in two groups (P=0.003). (ii) Correlation analysis of lead Ⅱ,Ⅲ, aVF with IRA: Lead of inferior wall elevation in IRALCX, 10 cases; nonelevation 20 cases. Lead of inferior wall elevation in IRARCA, 51 cases; nonelevation 13 cases with statistically significance in two groups (P<0.01). While ST elevated in both IRA for RCA and LCX, IRALCX,STⅡ≥STⅢ 7 cases; STⅢ>STⅡ 3 cases; IRARCA, STⅡ≥STⅢ 15 cases; STⅢ>STⅡ 36 cases with significant statistically meaning (P<0.05). (iii) Correlation analysis of chest lead V1-V9 for IRA, non-statistically meaning was measured. Conclusion IRA for LCX in acute myocardial infarction may have such characteristics as neither obvious depression in lead Ⅰ, aVL; nor obvious elevation in lead Ⅱ,Ⅲ,aVF. While both IRA for LCX and RCA with inferior wall elevation , IRALCX is likely to be STⅡ≥STⅢ.
		2015 Vol. 24 (6): 419-422 [Abstract] ( 1498 ) [HTML 1KB] [ PDF 878KB] ( 1670 )

	423	Investigation of the relationship between the fragmented QRS and N-terminal pro-B-type natriuretic peptide
		CAO Mu-Gen, ZHANG Wen-Jie, LIN Ping, ZHENG Wei-Ping
		Objective To investigate the relationship between the fragmented QRS complex(fQRS) and N-terminal pro-B type natriuretic peptide (NT-proBNP). Methods One hundred and two patients with fQRS were selected, and ninety eight patients with no fQRS and no ventricular block were selected as the control group, to compare the difference in NT-proBNP level between the two groups. Based on the occurrence of fQRS lead, the observation group was divided into three subgroups: 1) limb lead, 2) chest lead, and 3) chest lead and limb lead. By comparing the differences in NT-proBNP level among the subgroups, Spearman correlation analysis was conducted. Results NT-proBNP levels were significantly higher in the fQRS group, compared to the control group (P<0.01); NTproBNP levels were also significantly higher in subgroups 2) chest lead, and 3) the chest lead and the limb lead, compared to subgroup 1) limb lead (P<0.01); compared with subgroup 2)chest lead, subgroup 3) chest lead and limb lead has higher NT-proBNP levels (P<0.01);The NT-proBNP values of three groups have a positive correlation. The distribution range of fQRS lead was positively correlated with the NT-proBNP value.Conclusion NT-proBNP levels in patients with fQRS are higher than those normal person and the distribution range of fQRS lead and NT-proBNP level are positively correlated. It has certain clinical value for the diagnosis and prognosis of patients with chronic heart failure.
		2015 Vol. 24 (6): 423-426 [Abstract] ( 798 ) [HTML 1KB] [ PDF 882KB] ( 1387 )

	426


		2015 Vol. 24 (6): 426-426 [Abstract] ( 510 ) [HTML 1KB] [ PDF 834KB] ( 1124 )

	427	Analysis of Tp-Te and its clinical significance in patients with type 2 diabetes mellitus
		TANG Wen-Hong, HUANG Ying, TIAN Xiao-Fen, CHEN Xiao-Jie, ZHONG Hua, ZHANG Qin
		目的分析2型糖尿病患者T波峰末间期(Tpeak-interval,Tp-Te)的变化,并探讨其与室性心律失常的关系。方法选择60岁以下无心脏疾病的2型糖尿病患者60例(DM组)与60例健康者(对照组),进行常规12导联心电图及动态心电图检查,并对两组病例的一般临床资料、Tp-Te、Tp-Te间期离散度(Tp-Ted)、室性心律失常的发生进行比较。结果①DM组体质量指数、空腹血糖、糖化血红蛋白、尿酸、空腹胰岛素、总胆固醇、低密度脂蛋白、心率均高于对照组(P<0.05);V5导联Tp-Te明显延长(P<0.05);Tp-Ted较对照组显著延长(P<0.01),心律失常的发生率明显增高(P<0.01);② DM组中随着Tp-Te的延长,室性心律失常的发生率明显增高(P<0.05)。结论糖尿病患者易出现心肌电活动的不稳定,诱发心律失常的发生,Tp-Te能够反映心室跨壁复极离散度,可作为2型糖尿病患者室性心律失常发生的预测指标
		2015 Vol. 24 (6): 427-430 [Abstract] ( 1154 ) [HTML 1KB] [ PDF 870KB] ( 1593 )

	431	Relation of CHA₂DS₂-VASc score to the efficacy of radiofrequency catheter ablation for patients of different sex with paroxysmal atrial fibrillation
		ZHANG Qi-Yin, ZHANG Jing-Yun, ZENG Xian-Sheng, ZHANG Yu-Zhen, HUI Jie
		Objective To investigate the correlation betweenCHA₂DS₂-VASc score and recurrence of paroxysmal atrial fibrillation(PAF) after radiofrequency catheter ablation(RFCA) and examining the prognostic value of CHA₂DS₂-VASc score for recurrence of PAF in patients of different sexes after radiofrequency catheter ablation. [WTHZ]Methods[WT]One hundred and two patients diagnosed with PAF were analyzed in this study. Patients were categorized into two groups that were male group and female group. Recurrence of PAF were confirmed by electrocardiogram or dynamic electrocardiogram through regular followup. Multivariate Cox proportional hazards as performed to examine the relationship between CHA₂DS₂-VASc score and the recurrence of PAF. KaplanMeier estimation with a Logrank test was used for analysis of the influence of different sexes on recurrence of PAF and comparison of the accuracy, sensitivity, specificity, positive and negative predictive value of predicting AF recurrence when CHA₂DS₂-VASc score = 2 or 3. Results After a mean followup of twelve months, atrial fibrillation recurrence rate was 28.4%. Following multivariate Cox analysis，CHA₂DS₂-VASc score was confirmed to be the independent risk factor for recurrence of atrial fibrillation（RR1.896，95% CI 1.3852.596，P＝0.000）.Through multivariate Cox analysis, the recurrence rates of male and female groups were 25.8% and 33.3% , respectively. For male group, the accuracy, sensitivity, specificity, positive and negative predictive value of predicting AF recurrence were 0.637, 0.706, 0.612, 0.387 and 0.857 when CHA₂DS₂-VASc score = 2,and were 0.742, 0.353, 0.878, 0.500 and 0.796 when CHA₂DS₂-VASc score = 3. For female group, the accuracy,sensitivity, specificity, positive and negative predictive values of predicting AF recurrence were 0.556, 0.917, 0.375, 0.423 and 0.900 when CHA₂DS₂-VASc score = 2, and were 0.667, 0.583, 0.708, 0.500 and 0.773 when CHA₂DS₂-VASc score = 3. Conclusion Increased CHA₂DS₂-VASc score levels of patients with PAF undergoing RFCA were associated with a higher rate of recurrence of atrial fibrillation. CHA2DS2VASc score =2, both for males and females, as a standard for predicting recurrence has clinical significance.
		2015 Vol. 24 (6): 431-436 [Abstract] ( 3031 ) [HTML 1KB] [ PDF 978KB] ( 1444 )

	437	Study on early heart damage and ECG changes among masked hypertension patients
		HUANG Jian-Qiang, MO Xin, LI Yan-Zhuang
		Objective To study early heart damage and changes of masked hypertension patients，provide the basis to reduce the incidence of masked hypertension and the incidence of cardiocerebral vascular disease. Methods Select 135 cases of masked hypertension patients on March 2013May 2015 hospitalized in our hospital and clinic diagnosis of occult group to observe group, and 140 sustained hypertension subjects were included in control group，analysis of the two groups of ECG changes. Results The T wave change rate, rate of ST-T change, bundle branch block rate, rate of left ventricular hypertrophy, left ventricular pressure ratio in Observe group was significantly lower than that in control group, the differences between the two groups was statistically significant (P<0.01). There was no significant difference in prevalence of P-wave broadening and prevalence of P-wave bimodal changes between control group and observe group. As the growth of age, the rate of abnormal ECG increased gradually. Conclusion It's Closely related to early heart damage and ECG changes among masked hypertension patients, P wave broadening and bimodal change may be the sensitivity index.
		2015 Vol. 24 (6): 437-439 [Abstract] ( 1182 ) [HTML 1KB] [ PDF 913KB] ( 1448 )

	440	Clinical value of ST-segment elevation index fall in predicting left ventricular function of acuteST-segment elevation myocardial infarction patients
		ZHAO Qiu-Shi, WANG Da-Jie, SUN Jian-Ping, LI Xin-Dong, SHI Ying-Qiu
		Objective To investigate the relationship between ST-segment elevation index(∑STI) and left ventricular function for acute ST-segment elevation myocardial infarction(STEMI) patients. Methods According to the circumstance of ∑STI fall after percutaneous coronary intervention(PCI), 72 acute STEMI patients who had undergone emergency treatment of PCI directly were divided into ST-segment fall group and non-ST-segment fall group. The following items were observed in the two groups, including age, sex, history of smoking, anterior myocardial infarction, history of hyperlipidemia, history of hypertension, history of angina pectoris, CK-MB , history of type 2 diabetes, onset & visiting time, Killip classification, and left ventricular ejection fraction(LVEF) in hospital and 6 months after direct PCI. ResultsNo statistically significant difference in age, sex, infarct sites, history of angina pectoris, CK-MB, Killip classification, etc. was existed between the two groups(P>0.05). However, LVEF of ST-segment fall group in hospital and 6 months after direct PCI were significantly higher than that of non-ST-segment fall group, with statistically significant difference(P<0.05). Conclusion ∑STI has great clinical value in predicting left ventricular function of acute ST-segment elevation myocardial infarction patients.
		2015 Vol. 24 (6): 440-442 [Abstract] ( 1140 ) [HTML 1KB] [ PDF 951KB] ( 1463 )

	443	The ECG changes in pheochromocytoma
		XI Xin, GUO Hui-Ling
		Objective To investigate the ECG changes in pheochromocytoma. [WTHZ]Methods[WT]43 cases of pheochromocytoma patients preoperative ECG examination, patients with preoperative have high blood pressure can be divided into group A (13 cases), no high blood pressure in group B (30 cases), compare electrocardiogram change difference between two groups have statistical significance. [WTHZ]Results[WT]Group A and group B preoperative STT change of 7 cases respectively, 9 cases; A total of 16 cases of about 37.2%. Left ventricular surface of high voltage respectively 4 cases, 1 case; A total of 5 cases of about 11.6%. Sinus arrhythmia in 1 case, respectively, 1 case, a total of 2 cases, accounting for about 4.65%; Left anterior branch block respectively 0 cases, 2 cases; Acceleration border sex rhythm of the heart in 1 case, respectively, 0 cases; Right ventricular surface of high voltage respectively 0 cases, 1 case; Room sex premature beat respectively 0 cases, 1 cases; Ventricular premature beat, respectively 0 cases, 1 cases; Early bipolar respectively 0 cases, 1 cases. Conclusion group A and group B preoperative ecg STT change, the difference between the two groups has no statistical significance, preoperative electrocardiogram (ecg) changes in STT in the majority, A total of 16 cases accounted for about 37.2%, consider possible for pheochromocytoma hypersecretion catecholamine caused by myocardial injury. Group A and group B increased preoperative electrocardiographic left ventricular surface voltage, the difference between the two groups was statistically significant, considering possible reasons for A group of sustained high blood pressure, so compared with group B were more likely to overload caused by sustained hypertension left ventricular contraction caused in addition to the electric power increase，Characterized by increased left ventricular surface voltage. Preoperative ecg sinus arrhythmia group A and group B, the difference between the two groups have no statistical significance, sinus arrhythmia group A and group B are all young people is normal physiology reaction.
		2015 Vol. 24 (6): 443-445 [Abstract] ( 1188 ) [HTML 1KB] [ PDF 918KB] ( 1825 )

	446	Clinical manifestations and ECG features of 113 elderly diabetics with painless acute myocardial infarction
		SHI Hui, LI Dong-Juan, MENG Qing-Hui, YANG Li
		Objective To investigate the electrocardiogram(ECG) features and clinical manifestations of diabetics with painless acute myocardial infarction(AMI). Methods Two hundred and sixtytwo diabetics with AMI were selected, and divided into chest painless group(113 cases, group A) and pain group(149 cases, group B) separately. The clinical data and ECGs of the two groups were comparatively analyzed. Results In group A, infarcts were mainly observed in inferior wall, and the locations of ST-segment elevation and infarct were more than those in group B. In group B, the majority of infarcts occurred in front wall. The differences between the two groups were statistically significant(P<0.05). The incidences of chest pain, palpitation and syncope in group A were lower than those in group B, with statistically significant differences(P<0.05). The incidences of shortness of breath, toothache and nausea in group A were higher than those in group B, with statistically significant difference(P<0.05). The fatality rate of group A was higher than that of group B, with statistically significant differences(P<0.05). ConclusionFor the uncharacteristic clinical symptoms of diabetes complicating painless AMI in elderly people, the visiting time is prone to be postponed, partly resulting in high fatality rate. Clinicians should raise the understanding of diabetes complicating painless AMI, in order to reduce mortality and increase cure rate.
		2015 Vol. 24 (6): 446-448 [Abstract] ( 1050 ) [HTML 1KB] [ PDF 855KB] ( 1317 )

	449	The diagnostic value of treadmill exercise testing in male patients and female patients before or after menopause with coronary artery disease
		YU Ting
		Objective To study the diagnostic value and characteristics of treadmill exercise testing(TET) in male patients and female patients before or after menopause with coronary artery disease(CAD). [WTHZ]MethodsOne hundred and sixtytwo patients who were proposed to diagnose with coronary artery disease and coronary angiography were performed treadmill exercise testing.Male patients as group A, female patients after menopause as group B, female patients before menopause as group C, analyze and contrast the results of TET and CAG. [WTHZ]Results[WT]The positive rate of TET for the diagnosis of CAD was 74.7％,the negative rate is 76％,sensitive rate is 78.3％, the specificity rate is 72.2％, the accuracy rate is 75.3％. The difference of diagnosis rate between aftermenopause patients and male patients was nonstatistical significance. The diagnosis rate of aftermenopause patients and male patients was higher than the diagnosis rate of beforemenopause patients. The difference of diagnosis rate between aftermenopause patients with male patients and beforemenopause was statistical significance. The TET Ⅱ、Ⅲ lead aVF ST segment change those criminals are right coronary artery vessels,lead V1～V6 ST segment change those criminals blood vessels are left anterior descending coronary artery.Conclusion The TET is an important means of diagnosing coronary artery disease and can judge the places of the criminal vascular preliminary. The diagnosis of female patients before or after menopause with coronary artery disease should be cautiously.
		2015 Vol. 24 (6): 449-451 [Abstract] ( 1005 ) [HTML 1KB] [ PDF 866KB] ( 1653 )

	452	ECG diagnosis of acute pulmonary embolism complicating acute coronary syndrome
		ZHANG Jian-Yi, ZHANG Yu-Zhong
		It is particularly important to give patients with acute pulmonary embolism(APE) complicating acute coronary syndrome(ACS) correct and timely diagnosis and treatment for its severity. When persistent chest pain, serious right ventricular dysfunction, and refractory atrial arrhythmia occur in APE patient, APE complicating ACS should be considered. The most convenient and practical diagnostic tool is electrocardiogram(ECG), and the diagnostic criteria are summarized as follows: (i) the conventional ECG changes of APE +ST segment changes in left chest leads; (ii) T wave inversions are mostly found in Ⅲ, V1, and V2 lead of APE patients, with the deepest in V2 lead while they synchronously appear in left chest leads, deeper and wider than those in right chest leads; (iii) ST segment elevation is observed in right chest leads and aVR lead.
		2015 Vol. 24 (6): 452-456 [Abstract] ( 1069 ) [HTML 1KB] [ PDF 8362KB] ( 1208 )

	456


		2015 Vol. 24 (6): 456-456 [Abstract] ( 447 ) [HTML 1KB] [ PDF 844KB] ( 1083 )

	457


		2015 Vol. 24 (6): 457- [Abstract] ( 521 ) [HTML 1KB] [ PDF 329KB] ( 1111 )

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