JOURNAL OF PRACTICAL ELECTROCARDIOLOGY

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JOURNAL OF PRACTICAL ELECTROCARDIOLOGY

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JOURNAL OF PRACTICAL ELECTROCARDIOLOGY

	2016 Vol.25 Issue.5 Published 2016-10-28

Article

	305	Congenital long-QT syndrome
		JI Zhen-Guo, MA Guo-Ping
		This paper mainly discusses the different manifestations, clinical diagnosis and treatment of commonly seen congenital long-QT syndrome. The past two decades has witnessed dramatic changes of its treatment. This paper gives a brief introduction to its risk stratification and screening of suspected patients, and also provides suggestions for young athletes with LQTS. For the cases with a medical history of syncope or convulsion, especially with a family history of inexplicable sudden death among firstdegree relatives, LQTS-related examination and diagnosis should be recommended. The treatment for congenital LQTS includes changes of life style, and rational drug and non-drug therapies.
		2016 Vol. 25 (5): 305-308 [Abstract] ( 988 ) [HTML 1KB] [ PDF 1064KB] ( 1961 )

	309	Drug and device therapies of congenital longQT syndrome
		LIU Hong-Bin
		Congenital longQT syndrome(LQTS) is characterized by the prolongation of QT interval in ECG and relevant torsade de pointes(TdP), which easily leads to sudden cardiac death. Its risk factors include the length of QTc interval, genotype, medical history of syncope, etc. The treatment of congenital LQTS involves β blockers, surgical left cardiac sympathetic denervation(LCSD), cardiac pacing and implantable cardioverter defibrillators(ICD). β blockers are the firstline treatment for all the LQTS patients. Cardiac pacing therapy is fit for LQTS patients complicating bradycardia, which can significantly reduce the recurrence rate of cardiac events, but not the mortality. Highrisk LQTS patients should be implanted with ICD. Less subcutaneous complications of ICD are found and thus the therapy is worthy of being promoted. LCSD is poorly practical and is more suitable for those ICDimplanted patients frequently undergoing electroshock.
		2016 Vol. 25 (5): 309-312 [Abstract] ( 858 ) [HTML 1KB] [ PDF 880KB] ( 1485 )

	313	Acquired long-QT syndrome and torsade de pointes
		LIU Zhi-Hong, WANG Xiao-Yan, ZHANG Yun-Zhe, ZHI Ya-Xin
		Long-QT syndrome(LQTS) is characterized by prolongation of ventricular repolarization time, and increase of inhomogeneity and dispersion. LQTS is dangerous because it may lead to torsade de pointes(TdP) and ventricular fibrillation. The clinical manifestations include syncope, tetany or sudden death. LQTS includes congenital longQT syndrome(cLQTS) and acquired long-QT syndrome(aLQTS). The latter is more frequently seen in clinical practice than the former, and is potentially lethal, which makes it one of the most important reasons for sudden cardiac death in hospital. In the calculation of QT/QTc intervals, to evaluate ventricular repolarization as accurately as possible in different methods within the recommended range of critical value of QT/QTc interval prolongation time can predict the occurrence of TdP and further reduce the rate of sudden death.
		2016 Vol. 25 (5): 313-316 [Abstract] ( 998 ) [HTML 1KB] [ PDF 899KB] ( 1520 )

	316


		2016 Vol. 25 (5): 316-316 [Abstract] ( 597 ) [HTML 1KB] [ PDF 856KB] ( 965 )

	317	Diagnostic value of special orientation of lead aVR for coronary heart disease
		ZHANG Jian-Yi, ZHANG Yu-Zhong
		Lead aVR is located on upper right shoulder in frontal plane lead system, overlooking the whole ventricular chamber, and therefore it is called cavity lead. The electrical activity of the whole endocardium can be recorded by lead aVR, which is important for the diagnosis of coronary heart disease. Its diagnostic value is higher than any other unipolar lead or multiple leads, especially for left main coronary artery (LMCA) obstruction and multivessel disease, etc. The contralateral lead of lead aVR, lead “－aVR” arranges frontal plane lead system in order of spatial excitation sequence of the heart. It is more logical and is coincident with the excitation order of the heart, which makes it possible to diagnose inferior wall and high lateral wall acute myocardial infarction. This paper reviews on the clinical application of lead aVR and “－aVR”, combined with overseas literatures in recent years.
		2016 Vol. 25 (5): 317-321 [Abstract] ( 1278 ) [HTML 1KB] [ PDF 6000KB] ( 2028 )

	322	Diagnostic value of ST segment elevation in lead aVR for patients with left main coronary artery and (or)3 vessel disease
		ZHANG Yu-Zhong, ZHANG Jian-Yi
		Severe coronary artery diseases include acute complete or subtotal occlusion of left main coronary artery(LMCA) and 3vessel disease(3vd). Although the patients with acute complete occlusion of LMCA rarely arrive to hospital alive, the specificity and accuracy rate of ST segment elevation in lead aVR are both above 80%. For the patients with acute subtotal occlusion of LMCA and 3 vd, its diagnostic value is higher than that of any other single lead or multiple ones. The higher the amplitude of ST segment elevation in lead aVR is and the longer the duration is, the more serious the patients condition is. This paper reviews the diagnostic criteria of ST segment elevation in lead aVR, electrophysiological mechanism and overseas research progress.
		2016 Vol. 25 (5): 322-327 [Abstract] ( 1156 ) [HTML 1KB] [ PDF 995KB] ( 3434 )

	328	The significance of lead aVR ST segment changes in the diagnosis and differential diagnosis of different coronary artery diseases
		ZHANG Jian-Yi, ZHANG Yu-Zhong
		The elevation and depression of lead aVR ST segment in electrocardiogram may result from left main coronary artery(LMCA) or its major branches diseases. However, the risk stratification and clinical prognosis of myocardial ischemia or myocardial infarction due to different vascular lesions are rather different from each other. Therefore, it is important to make diagnosis and differential diagnosis of different coronary artery diseases. The changes of ST segment in lead aVR have important clinical significance, the diagnostic and differential diagnostic values of which are higher than any other single lead or multiple leads. This paper reviews on the diagnostic and differential diagnostic significance of the elevation and depression of lead aVR ST segment for different coronary artery diseases, diagnostic criteria and the latest overseas research progress in recent years.
		2016 Vol. 25 (5): 328-333 [Abstract] ( 1108 ) [HTML 1KB] [ PDF 1154KB] ( 1794 )

	334	Efficacy and safety of dabigatran perioperative anticoagulation for patients undergoing catheter ablation of nonvalvular atrial fibrillation: a Metaanalysis
		ZHENG Wei-Ping, CHEN Feng, LI Yong-Kun, LIN Kai-Yang, JIANG Yun
		Objective To systematically evaluate the efficacy and safety of dabigatran perioperative anticoagulation for patients undergoing catheter ablation of nonvalvular atrial fibrillation. Methods We collected research literature of randomized controlled trials (RCTs) or nonRCTs about perioperative anticoagulation for patients undergoing catheter ablation of nonvalvular atrial fibrillation from databases including PubMed, EMbase, The Cochrane Library (Issue 2, 2016), CMB, CNKI, Wanfang and VIP with computer. Two evaluators independently screened literatures, extracted data and assessed the bias risk of included studies, and then performed Metaanalysis by using software of RevMan 5.3. Results A total of 23 studies involving 7 673 patients were finally enrolled in Metaanalysis. It showed no statistically significant difference in the incidence of cerebral apoplexy or transient cerebral ischemia between dabigatran and warfarin groups(OR=1.0, 95%CI：0.60-1.68, P=0.99), and so did the incidence of hemorrhoea event(OR=0.79, 95%CI：0.52-1.19, P=0.25). The incidence of minor hemorrhoea event in dabigatran group was significantly decreased than that in warfarin group(OR=0.71, 95%CI：0.57-0.87, P=0.001). Conclusion There was no significant difference in the efficacy of perioperative anticoagulation for patients undergoing catheter ablation of nonvalvular atrial fibrillation and incidence of complication of hemorrhoea between dabigatran and warfarin. For patients taking dabigatran, the incidence of complication of minor hemorrhoea is reduced if compared with those taking warfarin.
		2016 Vol. 25 (5): 334-341 [Abstract] ( 1090 ) [HTML 1KB] [ PDF 1481KB] ( 1250 )

	342	Analysis of heart rate variability and blood pressure variability in patients with essential hypertension complicating acute cerebral infarction
		WANG Xian-Yun, WANG Ren, HAN Wei-Xing, ZHENG Lin-Lin
		Objective To investigate the heart rate variability(HRV) and blood pressure variability(BPV) in patients with essential hypertension complicating acute cerebral infarction. Methods A total of 82 patients with essential hypertension complicating acute cerebral infarction and 108 patients with pure essential hypertension were enrolled in our study. Their ambulatory electrocardiography and ambulatory blood pressure were measured synchronously. Indices of HRV and BPV were calculated by computer automatically. Results Compared with pure essential hypertension group, the value of each HRV index was lower in cerebral infarction group, with statistically significant difference(P<0.05). In cerebral infarction group, the descending rate of nocturnal blood pressure was lower than that in pure essential hypertension group while the value of each BPV index was higher. And there were statistically significant differences(P<0.05) in the descending rate of nocturnal diastolic blood pressure, 24hour average systolic blood pressure(24 h SBP) and 24hour systolic blood pressure coefficient of variation(24 h SCV) between the two groups.Conclusion The autonomic nervous function of the patients with essential hypertension complicating acute cerebral infarction is significantly impaired if compared with the cases attacked by pure essential hypertension. It[LM]is clinically significant for evaluating severity and improving prognosis of hypertensives and those complicating acute cerebral infarction to make tracing observation on changes of HRV and BPV indices.
		2016 Vol. 25 (5): 342-345 [Abstract] ( 939 ) [HTML 1KB] [ PDF 873KB] ( 1433 )

	346	Clinical study of trimetazidine in improving the life quality of patients after coronary stent implantation
		YUAN Wei, ZHANG Wei, LI Xiao-Rong, CAO Ke-Jiang
		Objective To investigate the effect of trimetazidine in improving the life quality of patients with coronary disease after coronary stent implantation. Methods Seventytwo patients implanted with coronary stent were randomly divided into two groups: treatment group and control group. Patients in the treatment group took trimetazidine combined with essential drugs of coronary heart disease persistently while the ones in the control group only accepted therapy with essential drugs. Before the operation one year later, questionnaire survey was performed with the MOS item short from health survey(SF-36). Results In terms of each basic value in SF-36 health survey table, there was no statistically significant difference between the two groups before the implantation(P＞0.05). One year after the operation, there were statistically significant differences in the indices of physiological functions, physical pain, overall health, vitality and social ability in SF-36 health survey table(P＜0.05). Conclusion Taking trimetazidine can improve the life quality of patients with coronary heart disease after coronary stent implantation.
		2016 Vol. 25 (5): 346-348 [Abstract] ( 858 ) [HTML 1KB] [ PDF 949KB] ( 1224 )

	349	Pre-excitation wave analysis in patients with manifest pre-excitation syndrome after treadmill exercise test
		LU Yong-Ping, YU A-Xin, CHEN Teng, SONG Ge, ZHOU Yun-Jie, YU Dong
		Objective To analyze the morphologic changes of preexcitation waves in patients with manifest preexcitation syndrome after treadmill exercise test(TET). Methods One hundred and sixty 15-40 year old patients with manifest preexcitation syndrome were selected. The morphologic changes of preexcitation waves were observed during the process of TET, and the proportion of disappeared preexcitation waves was recorded and analyzed. Results The total proportion of disappeared preexcitation waves was 12.5% after TET in patients with manifest pre-excitation syndrome. The secondary ST-T changes returned to normal with the disappearance of preexcitation waves. The ratio of disappeared pre-excitation waves in type A pre-excitation syndrome group was significantly higher than that in type B pre-excitation syndrome group. Conclusion With heart rate increases after TET, preexcitation waves may disappear in parts of patients with manifest pre-excitation syndrome.
		2016 Vol. 25 (5): 349-351 [Abstract] ( 1014 ) [HTML 1KB] [ PDF 860KB] ( 1564 )

	352	Clinical study on cardiac injury after intensitymodulated radiation therapy for lung cancer
		GENG Xu-Hong, YIN Xi, LIANG Xu-Fei, YANG Hua, GONG Xiao-Hong, LI Zeng-Ping
		Objective To discuss the manifestations of acute cardiac injury after intensity modulated radiation therapy(IMRT) for lung cancer. Methods Fiftysix patients with lung cancer were selected who had undergone IMRT from December 2014 to June 2016. Electrocardiogram(ECG) and echocardiography examinations were performed on them before IMRT, within one week and two months after IMRT by simultaneously integrated boost technology. Results The incidence of acute cardiac injury was 53.6%(30 cases) after radiotherapy and the injuries were graded in level Ⅰ. Among those patients with acute cardiac injury, there were 24 cases found ECG abnormalities, mainly sinus tachycardia(19 cases)， and there were 4 cases with ST-T changes, one case with low voltage in limb lead, two cases with pericardial effusion, and 4 cases with left ventricular systolic dysfunction. Conclusion The incidence of acute cardiac injury is low in patients with lung cancer and most of cardiac injuries are ECG abnormalities.
		2016 Vol. 25 (5): 352-354 [Abstract] ( 800 ) [HTML 1KB] [ PDF 925KB] ( 1391 )

	354


		2016 Vol. 25 (5): 354-354 [Abstract] ( 441 ) [HTML 1KB] [ PDF 893KB] ( 890 )

	355	Application value of ambulatory electrocardiography examination in screening sleep apnea syndrome
		ZHANG Xi-Lan, WU Yue-Ping
		Objective To investigate the application value of ambulatory electrocardiography(AECG) examination in screening sleep apnea syndrome(SAS). Methods AECG examination was performed on 121 patients with different degrees of sleep snoring. AECG and respiratory waves were extracted synchronously with secondgeneration SAS initial screening technology by DMS Company. Meanwhile, polysomnography(PSG) examination was performed on the patients and positive rate was compared. Results In 121 enrolled patients, PSG examination reported 40 negative cases and 81 positive ones including 25 with mild SAS, 42 with moderate SAS and 14 with severe SAS. AECG examination found 46 negative cases and 75 positive ones. There were 72 cases found positive both in AECG examination and PSG monitoring. The diagnostic positive rate of AECG and PSG were coincident for patients with moderate and severe sleep snoring. However, the detection rate of AECG was comparatively lower in patients with mild sleep snoring, and false positive phenomenon was observed. For moderate and severe SAS patients, the positive detection rate of AECG was significantly higher than that of mild cases, with statistically significant difference(P<0.05). Conclusion AECG is an easy, convenient, practical and reliable method to detect SAS. For its great effect in screening SAS, AECG can be recommended for clinical diagnosis.
		2016 Vol. 25 (5): 355-358 [Abstract] ( 1012 ) [HTML 1KB] [ PDF 1127KB] ( 1448 )

	359	Clinical study on the relationship between plasma resistin level and atrial fibrillation
		WANG Mei-Xiang, YIN Yi-Gang, CHEN Ge-Cai
		Objective By measuring the level of plasma resistin, to study its roles in the occurrence and maintenance of lone atrial fibrillation(LAF), and analyze the related influential factors of plasma resistin level and risk factors of AF. Methods Research objects were 140 patients consulting in the department of cardiology of our hospital because of palpitation from June to December in 2014. The experimental group consisted of AF patients who were classified into patients with LAF(60 cases) and those with AF complicating hypertension(55 cases), respectively. The LAF cases were further divided into paroxysmal AF group and persistent AF group, each with 30 cases. In the control group were normal people(25 cases). The difference of plasma resistin level was analyzed between AF patients and normal people by oneway abalysis of variance, and its related influential factors for AF patients were analyzed in methods of Pearson correlation analysis and multiple linear regression. Logistic regression was applied in analyzing risk factors of AF. Results (i) In terms of high sensitive C reactive protein( hs-CRP) and plasma resistin level, the levels of AF group were all higher than those of control group; among the AF patients, the levels of LAF group were lower than those of AF complicating hypertension group and the levels of paroxysmal AF group were lower than those of persistent AF group. (ii) Pearson correlation analysis showed that plasma resistin level was positively correlated with hs-CRP level(r=0.530, P=0.000), left atrial diameter(r=0.265, P=0.004) and systolic blood pressure(SBP)(r=0.364, P=0.000). Multiple linear regression analysis further revealed that there was a linear relationship among SBP, hs-CRP and plasma vesistin levels: Y=-2.172+0.089 SBP+1.347 hs-CRP(R²=0.307, P<0.05). (iii) Logistic regression analysis indicated that plasma resistin and hs-CRP levels were both enrolled into the regression equation, with OR>1. Conclusion (i) The level of plasma resistin in LAF group was significantly higher than that in control group, especially the cases in persistent AF group, which indicated that resistin participated in the occurrence and maintenance of AF. (ii) Plasma resistin level was positively correlated with hs-CRP level. It implied that the occurrence of AF may be related with some inflammatory characteristics of resistin, which suggested that resistin could give rise to inflammatory reaction and participate in the occurrence and maintenance of AF with inflammatory mediators. (iii) Plasma resistin level increased significantly in AF patients complicating hypertension and showed synergistic effect, which suggested possible potentiality of resistin in expressing hypertension and AF independently. Meanwhile, the study also demonstates that hypertension is a risk factor of AF. It might be suspected that resistin can impact on AF via hypertension.
		2016 Vol. 25 (5): 359-362 [Abstract] ( 917 ) [HTML 1KB] [ PDF 915KB] ( 1208 )

	363	Clinical analysis on ambulatory electrocardiography of patients with paroxysmal atrial fibrillation
		LI Xiao-Xia, YANG Ling-Ling
		Objective To explore whether there exists circadian rhythm in the duration of paroxysmal atrial fibrillation(PAF) and the relationship between PAF and gender, age and left atrial diameter(LAD). Methods In our study, PAF group consisted of 66 PAF inpatients or outpatients who had undergone 24hour ambulatory electrocardiography(AECG) examination in our hospital. Another 60 inpatients were randomly selected as control group with atrial fibrillation (AF) excluded by AECG examination. Among 66 PAF cases, AECG data were analyzed and the duration of AF in each time period was recorded. At the same time, we compared gender, age and LAD between the two groups. Results The onset and duration of PAF followed circadian rhythm and were closely related to PAF patients age, LAD and other factors. Conclusion AECG examination is worthy of being popularized in PAF patients for its simplicity to operate, safety, reliability and good reproducibility.
		2016 Vol. 25 (5): 363-365 [Abstract] ( 1204 ) [HTML 1KB] [ PDF 873KB] ( 1229 )

	366	Application of lead aVR in differential diagnosis of tachycardia
		CHEN Xiu-Wen, ZHANG Shu-Long
		Lead aVR has not drawn enough attention for years in traditional ECG diagnosis. However, recent research revealed important roles it plays in many fields, especially in the differential diagnosis of ventricular tachycardia(VT) and supraventricular tachycardia(SVT). This paper briefly introduces the clinical value of lead aVR in the differential diagnosis of VT and SVT．
		2016 Vol. 25 (5): 366-368 [Abstract] ( 970 ) [HTML 1KB] [ PDF 875KB] ( 1381 )

	369	Comprehensive evaluation of atrial fibrillation prognosis by HATCH score system
		PENG Ming, ZHANG Shu-Long
		HATCH score stands for the influence of hypertension, age, cerebral ischemia event, chronic obstructive pulmonary disease and heart failure on the progression of atrial fibrillation(AF). It is applicable to evaluate the risk of paroxysmal AF developing into persistent AF within one year. Whether HATCH score can predict the prognosis of AF has become one of research hotspots clinically in recent years. Many researchers revealed the correlation between HATCH score and recurrence of AF after radiofrequency ablation or electrical conversion to sinus rhythm, which indicates HATCH score has important predictive value for AF prognosis. This review summarizes research advance about the comprehensive evaluation of AF prognosis by HATCH score in recent years.
		2016 Vol. 25 (5): 369-372 [Abstract] ( 1620 ) [HTML 1KB] [ PDF 913KB] ( 1728 )

	373
		XU Chun-Fang, YANG Xiao-Yun, WANG Tie-Mao

		2016 Vol. 25 (5): 373-375 [Abstract] ( 878 ) [HTML 1KB] [ PDF 3747KB] ( 1624 )

	376
		WU Mao-Yuan, GU Lian-Lian, ZOU Jian-Feng, GU Fa-Lin

		2016 Vol. 25 (5): 376-377 [Abstract] ( 929 ) [HTML 1KB] [ PDF 1975KB] ( 1530 )

	378
		YANG Gui-Ying

		2016 Vol. 25 (5): 378-380 [Abstract] ( 983 ) [HTML 1KB] [ PDF 6063KB] ( 1264 )

	380


		2016 Vol. 25 (5): 380-380 [Abstract] ( 367 ) [HTML 1KB] [ PDF 836KB] ( 1383 )

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