JOURNAL OF PRACTICAL ELECTROCARDIOLOGY

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JOURNAL OF PRACTICAL ELECTROCARDIOLOGY

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JOURNAL OF PRACTICAL ELECTROCARDIOLOGY

	2017 Vol.26 Issue.6 Published 2017-12-28

Article

	381


		2017 Vol. 26 (6): 381-456 [Abstract] ( 400 ) [HTML 1KB] [ PDF 1052KB] ( 1561 )

	384	The value of long-time ECG recorder in diagnosing arrhythmia
		LI Jing-Chao, DONG Shu-Juan, YU Hai-Jia, CHU Ying-Jie
		Objective To assess the clinical value of portable long-time ECG recorder in the diagnosis of arrhythmia.Methods A total of 67 patients suspected with arrhythmia were consecutively enrolled in our study. They had been admitted into Henan Provincial People's Hospital from January 1 to June 30 in 2017. All of the patients underwent 24hour Holter plus routine ECG examination and then longterm ECG monitoring for 30 days. The incidence of different types of arrhythmias in the above two methods was compared. Results Compared with 24hour Holter plus routine ECG examination, the detection rate of arrhythmia by 30day longterm ECG recorder was higher(82.1% vs.32.8%, P<0.001), especially for the rate of sinus arrest,atrial flutter,atrial fibrillation and ventricular tachycardia.Conclusion Portable longtime ECG recorder can significantly elevate the detection rate of arrhythmia, providing a new diagnostic method for arrhythmias impossible to be clearly diagnosed in the hospital.
		2017 Vol. 26 (6): 384-387 [Abstract] ( 859 ) [HTML 1KB] [ PDF 3957KB] ( 1584 )

	388	The construction and clinical application of remote ECG network system in regional medical center
		WANG Yan-Mei, LI Xing-Jie
		Jining No.1 People's Hospital has constructed ECG network information platform at the level of regional medical center. Network ECG machines or workstations are allocated in each branch hospital and union hospital, and they are connected with ECG diagnosis center of medical center by local area network within the hospital, wide area network among hospitals and network servers. Medical examination, data upload, diagnosis, return, results printing and data archiving are performed in the set process. The terminal ECG machines,workstations and servers in each branch hospital and ECG diagnosis center are connected with each other as an entirety by local and wide area networks. In the construction of remote ECG network in medical center, the system runs smoothly and operates conveniently. The construction of remote ECG network system in regional medical center can significantly improve the efficiency of clinical ECG examination and diagnosis in each hospital, and thus realize the homogeneity of ECG diagnosis service in regional medical center.
		2017 Vol. 26 (6): 388-390 [Abstract] ( 1263 ) [HTML 1KB] [ PDF 1140KB] ( 1488 )

	391	Evaluation on the operational performance of ECG diagnosis center against the background of homogenization construction of medical cluster: taking acute myocardial infarction as an example
		GUO Meng, XU Xia, ZHANG Tong, LI Xing-Jie
		Objective To evaluate the running efficiency of ECG diagnosis center, and to analyze the problems or flaws in the operation of homogenization network. Methods We selected 402 patients initially diagnosed with acute myocardial infarction(AMI) by our ECG diagnosis center from 2014 to 2016. Sixtynine cases among them were transferred into our hospital. Statistical analysis was carried out by SPSS 20.0 based on the database established by Excel. We made descriptive statistics of the operational performance of ECG diagnosis center. Results ECG diagnosis center made the same diagnosis as the admitting diagnosis on 82.6% of research objects. Among the enrolled patients, 33.3% underwent percutaneous coronary intervention(PCI) while 30.4% were performed percutaneous transluminal coronary angioplasty(PTCA). Their condition was improved after the procedure. AMI patients can be rescued within the shortest time of 9 minutes. Conclusion The running of ECG diagnosis center improves the medical service quality of primary hospitals. It provides better medical service for patients, relieves the imbalanced distribution of medical resources in society and reduces the economic burden of patients. In addition, it also increases the income of medical institutions. ECG diagnosis center has obtained great economic and social benefit.
		2017 Vol. 26 (6): 391-393 [Abstract] ( 586 ) [HTML 1KB] [ PDF 965KB] ( 1230 )

	394


		2017 Vol. 26 (6): 394-394 [Abstract] ( 381 ) [HTML 1KB] [ PDF 940KB] ( 1161 )

	395	Application of ECG scatterplot in analyzing competitive arrhythmias
		JING Yong-Ming, WANG Zhi-Hua, PAN Yun-Ping, SUN Chao-Yang, JING Yan, SHEN Ji-Hong, ZHANG Fang-Fang
		Objective To explore the application of ECG scatterplot in analyzing competitive arrhythmias, know its electrophysiological characteristics and lay foundation for rapidly analyzing ambulatory electrocardiography(AECG). Methods Typical AECG cases with common competitive arrhythmias including pararrhythmia, autonomous cardiac rhythm, escaped rhythm and multifocal atrial tachycardia were selected. The morphological features of their ECG scatterplots were analyzed while the electrophysiological characteristics were explored by using the reversal technique and based on AECG segments.Results An obvious feature of the Lorenz scatterplot of pararrhythmia was a Yshaped scatter set which sloped downwards to the right and was upside down. It indicated that the automatic rhythmicity of pararrhythmia did not rise or was slightly higher, not exceeding the variation range of sinus rhythm. By protective entrance block(without “perceptive” function for dominant rhythm), pararrhythmia can compete with sinus rhythm. The Lorenz scatterplot of autonomous cardiac rhythm was characterized by the fact that ventricular cycle(VV) and coupling interval(NV) was overlapping in sinus rhythm cycle(NN). It indicated that the automatic rhythmicity of lower pacemaker was slightly higher, reaching or slightly exceeding the frequency range of sinus rhythm. Autonomous cardiac rhythm competed with sinus rhythm by “strength”(increased automatic rhythmicity). Alternate autonomous cardiac rhythm and sinus rhythm repeated, which suggested there was no protective entrance block(with “perceptive” function for dominant rhythm). The Lorenz scatterplot feature of escaped rhythm was the squareshaped top outer boundary(capture rhythm of escape) at the distal end of constant velocity line(outside the 1.0 s line). It indicated that the automatic rhythmicity of escaped rhythm did not rise. Its rhythm readjusted at any time, suggesting there was no protective entrance block. Because of reduced dominant ventricular rate resulting from sinus node or atrioventricular nodal dysfunction, escaped rhythm can compete with dominant rhythm at a low level. The Lorenz scatterplot of multifocal atrial tachycardia was similar to the pie chart of atrial fibrillation. The automatic rhythmicity of several lower pacemakers significantly increased, almost replacing sinus rhythm; a small quantity of sinus beats can only possibly be found at the moment of block conduction from pacemakers at all levels; there was no changeless rhythm. It implied that each lower pacemaker was wellmatched in strength.Conclusion Common competitive arrhythmias are significantly characterized by ECG scatterplot which serves as a secret weapon for rapidly analyzing these kinds of AECGs. The electrophysiological meanings(including automatic rhythmicity, protective entrance block and intermittent efferent block) reflected by ECG scatterplot vary from each other, which provide important references for identification and nomenclature.
		2017 Vol. 26 (6): 395-407 [Abstract] ( 712 ) [HTML 1KB] [ PDF 5969KB] ( 1476 )

	408	The correlation between heart rate variability and outcome of radiofrequency catheter ablation guided by magnetic navigation system for patients with atrial fibrillation
		CHENG Yan, LI Ku-Lin, ZHENG Jie, LIU Xiao-Yu, ZHANG Chang-Ying, LI Zong-Bin, GUO Jin, ZHAO Xiao-Xi, YU Zhi-Ming, WANG Ru-Xing
		Objective To explore the relationship between heart rate variability(HRV) and outcome of radiofrequency catheter ablation(RCA) guided by magnetic navigation system for patients with atrial fibrillation(AF). Methods Fifty-eight AF patients who had undergone RCA guided by magnetic navigation system were enrolled consecutively. ECG and Holter recordings were performed, and HRV was analyzed. The recurrence of AF was observed. AF recurrence was defined as recurrence of atrial tachycardia, atrial flutter or AF lasting longer than 30 seconds three months after the procedure. Results Fifty patients were enrolled finally, and were followed up for an average of (15.56±4.60) months. AF recurrence was found in 20 patients and the mean recurrence time was (6.05±4.42) months after the procedure. In the AF recurrence group, the root mean square of successive R-R interval difference, proportion of R-R intervals differing from their neighbors by >50 ms, and highfrequency component three months after the procedure were significantly higher than those in the nonrecurrence group(P=0.036, 0.045 and 0.015, respectively) while low/highfrequency ratio(LF/HF) was significantly lower(P=0.015). COX survival analysis revealed that LF/HF was an independent risk factor of AF recurrence(P=0.010). Conclusion LF/HF three months after RCA guided by magnetic navigation system for AF patients may be an independent predictor of AF recurrence.
		2017 Vol. 26 (6): 408-412 [Abstract] ( 768 ) [HTML 1KB] [ PDF 1009KB] ( 1558 )

	413	Relationship between the new ST-T waves on SaahECG and critical lesion of coronary heart disease
		LI Mei-Juan, ZHANG Yan-Ping, WANG Yan, QU Hui-Min, HUANG Wei-Bin
		Objective To investigate the relationship between the new ST-T waves on precise new electrocardiogram(SaahECG) and critical lesion of coronary heart disease(CHD).Methods We selected 38 CHD patients as research objects who had been admitted into Xiamen Cardiovascular Hospital Affiliated to Xiamen University from June 2016 to September 2017. Coronary angiography indicated critical coronary artery lesions(about 70% of coronary artery stenosis) in them. Intravascular ultrasound(IVUS) inspection was performed to evaluate whether stent implantation was required. The research objects were scanned by SaahECG while Ri/Rt ratio was mapped and analyzed. The Ri/Rt ratio and IVUS results were statistically analyzed. Results For the patients with critical coronary artery lesions, it was found that Ri/ Rt ratio<1 if the plaque burden was less than 70% verified by IVUS and there was no necessity of further stent implantation; Ri/Rt ratio>1 if the plaque burden was over 70% evaluated by IVUS and there was need of further stent implantation.Conclusion SaahECG can scan, record and show the natural signals of new ST-T waveforms in human heart, which provides a new method for evaluating the need of further invasive interventional examination and therapy on patients with critical coronary lesions. The method is simple, convenient and noninvasive. It is expected to be a completely new body surface examination method for clinical diagnosis, disease assessment and treatment instruction.
		2017 Vol. 26 (6): 413-415 [Abstract] ( 632 ) [HTML 1KB] [ PDF 1445KB] ( 1393 )

	416	Clinical factor analysis on 600 hospitalized patients with atrial fibrillation
		XU Chun-Fang, WANG Yuan, HOU Yue-Mei, ZHANG Xiao-Qin
		Objective To make related clinical factor analysis on 600 hospitalized patients with atrial fibrillation(AF) in Shanghai Fengxian District Central Hospital. Methods Clinical data of 600 inpatients from 2015 to 2017 in our hospital were collected and retrospectively analyzed. Results (ⅰ) Among the 600 patients, males and females separately accounted for 45.2%and 54.8%. The sex ratio of male to female was 0.82 ∶1. Patients aged 71 to 80 years old accounted for the largest proportion(37.5%), followed by the patients aged 81 to 90 years old and those aged 61 to 70 years old, accounting for 25.2%and 20.8%, respectively. (ⅱ) AF patients complicating primary hypertension accounted for 57.3%and the sex ratio of male to female was 0.75 ∶1. The proportion of patients with grade3 hypertension, coronary heart disease(CHD), diabetes and thyroid dysfunction was 57.3%, 42.7%, 13.2%and 26.0%,respectively. (ⅲ) A total of 134 AF patients were complicated by cerebral apoplexy, accounting for 22.3%; those at high risk of hypertension accounted for 73.1%and CHD patients accounted for 60.4%. (ⅳ) Paroxysmal AF was observed in 134 cases(26.5%), and persistent and permanent AF in 441 cases(73.5%). Paroxysmal AF patients at a NYHA level of Ⅰ-Ⅱaccounted for 83.0%while persistent and permanent AF patients at the same level accounted for 52.2%(P<0.05). Conclusion The proportion of females among AF inpatients in our hospital was significantly higher than that of males. Hypertension, CHD, diabetes and advanced age are clinically related to AF.
		2017 Vol. 26 (6): 416-419 [Abstract] ( 688 ) [HTML 1KB] [ PDF 982KB] ( 1389 )

	420	Analysis on heart rate variability of patients with senile diabetes and coronary heart disease
		CHI Ye-Hong, WANG Xue-Rong, LIANG Juan, ZHANG Ming-Yue
		Objective To investigate the clinical significance of heart rate variability(HRV) by analyzing the ambulatory electrocardiographic manifestations of gerontal patients with diabetes and coronary heart disease(CHD). Methods Forty patients with type2 diabetes and 58 CHD patients complicating diabetes were enrolled in our study as diabetes group and diabetes complicating CHD group,respectively. Sixty healthy people were selected as the control group. Holter examination was performed on the three groups. The relationship between the incidence rate of arrhythmia(myocardial ischemia) and HRV was analyzed. Results Among the CHD patients with senile diabetes, the incidence rates of arrhythmia and myocardial ischemia were both significantly higher than those in the diabetes group and normal control group while the HRV indexes were significantly lower with statistically significant differences(P<0.05). Conclusion Senile diabetes and CHD can easily lead to cardiac autonomic nerve dysfunction and myocardial ischemia. The existence of complications is possibly one of the common inducing factors of arrhythmias.
		2017 Vol. 26 (6): 420-423 [Abstract] ( 584 ) [HTML 1KB] [ PDF 1002KB] ( 1225 )

	424	Application of ambulatory electrocardiography examination in diagnosing atrial fibrillation complicating second degree atrioventricular block
		GUO Xi-Mei
		Objective To discuss the efficacy of ambulatory electrocardiography(AECG) examination in diagnosing atrial fibrillation complicating second degree atrioventricular block(AVB). Methods Eighty-two patients with atrial fibrillation were inspected by AECG. They had been admitted to our hospital from April 2016 to May 2017. The effect of application of AECG in diagnosing atrial fibrillation complicating second degree AVB was analyzed. Results The mean RR interval of the patients with second degree AVB was significantly longer than that of the patients with first degree AVB, with statistically significant difference[(2.66±0.34) s vs. (2.22±0.23) s, P＜0.05]. The ventricular rate of the patients with second degree AVB was significantly lower than that of the patients with first degree AVB, with statistically significant difference[(71.17±6.40) times/min vs. (82.23±7.92) times/min, P＜0.05]. The ECG scatterplot of the patients with second degree AVB was characterized by balanced distributed wide strips with uniform width, obvious manifestations in upper boundary and no obvious manifestation in lower boundary. The scatterplot of the patients with first and third degree AVB was narrow in width; no significant feature was showed both in the upper and lower boundaries; the distribution density and width of scattered points was not significantly characteristic. Conclusion AECG examination can be applied in effectively monitoring the changes of heart rate and accurately providing information feedback of electrocardiographic changes. A combination of AECG examination and scatterplot can provide more accurate information in diagnosing atrial fibrillation complicating second degree AVB and improve the diagnostic accuracy of the disease.
		2017 Vol. 26 (6): 424-426 [Abstract] ( 588 ) [HTML 1KB] [ PDF 969KB] ( 1285 )

	427	The mechanism and clinical value of short P-R interval on ECGs of pregnant women
		ZHANG Liu-Fang
		Objective To discuss the mechanism and clinical value of short P-R interval on ECGs of pregnant women. Methods A total of 1 286 pregnant women were randomly selected from patients admitted into our hospital from January 2016 to January 2017. According to gestational weeks, they were divided into group A(422 cases, ≤13 weeks), group B(487 cases, 13<gestational weeks<28) and group C(377 cases, ≥28 weeks). Another 100 healthy non-pregnant women of the right age were taken as control group, who had undergone physical examination in our hospital during the same time period. ECG monitoring was performed on the three groups with the frequency of short P-R interval recorded, and the occurrence of sinus tachycardia and anemia was observed.Results The incidence of short P-R interval in group B and C was separately 4.52% and 7.16%, significantly higher than 1.00% in control group and 1.18% in group A, with statistically significant differences(P＜0.05). The incidence of anemia in group A, B and C was separately 3.79%, 7.39% and 11.40%, all significantly higher than 0.00% in control group. The incidence of sinus tachycardia in group B and C was separately 4.11% and 7.96%，also significantly higher than 0.00% in control group and 1.66% in group A. With the increasement of gestational weeks, the incidences of anemia and sinus tachycardia also markedly elevated(P＜0.05). Conclusion Compared with healthy non-pregnant check-up females of the right age, the incidence of short P-R interval significantly increased in middle and late pregnancy women. It is believed that increased gestational weeks contribute greatly to the occurrence of short P-R interval which is related to anemia and increased heart rate.
		2017 Vol. 26 (6): 427-429 [Abstract] ( 759 ) [HTML 1KB] [ PDF 971KB] ( 1404 )

	430	Beware of sustained ventricular tachycardia after cardiac resynchronization therapydefibrillator pacemaker implantation
		LIU Xia
		Cardiac resynchronization therapy(CRT) pacemaker refers to the trichamber pacemaker functioned with ventricular resynchronization therapy while CRTdefibrillator pacemaker is equipped with defibrillation function based on CRT pacemaker. At present, the two types of pacemakers have been applied widely in clinical practice, and experts have reached a consensus on individualized rational setting of pacemakers. This paper reports a failed case of CRT-D therapy, and we hope to attract more attention to individualized rational setting of pacemakers.
		2017 Vol. 26 (6): 430-436 [Abstract] ( 705 ) [HTML 1KB] [ PDF 21324KB] ( 1043 )

	437	An improved method for evaluating QT interval prolongation
		LIU Guo-Cai, LI Jie, JU Li-Zhong, MA Yu-Xian, JI Qiu-He
		Objective To develop a new method for evaluating QT interval prolongation and to demonstrate its validity. Methods A total of 1 634 healthy people were enrolled as research objects and their ECG data were divided into groups according to heart rate. The 97.5% quantile of QT interval at different heart rate was calculated; polynomial fitting of these QT quantiles and heart rate was performed; and then we obtained the risk line of nomogram for evaluating QT interval prolongation. The new QT nomogram, Chan's nomogram and Bazett's formula(QTc=440 ms) were separately utilized in diagnosing congenital long QT syndrome(LQTS) and druginduced torsade de pointes(TdP). The diagnostic efficiency was compared among the three methods. ResultsIn the diagnosis of congenital LQTS, the sensitivity and specificity of the new QT nomogram was 95.7% and 97.5%, respectively; Chan's nomogram showed a sensitivity of 74.1% and a specificity of 99.2%; the sensitivity and specificity of Bazett's formula was separately 98.6% and 90.5%. In the diagnosis of druginduced TdP, the sensitivity and specificity of the new QT nomogram was 95.8% and 97.1%, respectively; Chan's nomogram showed a sensitivity of 90.2% and a specificity of 99.3%; the sensitivity and specificity of Bazett's formula was separately 97.2% and 86.8%. Conclusion The new QT nomogram we developed is a simpletouse tool for clinical risk evaluation. It can predict risks for congenital LQTS and druginduced TdP more precisely if compared with other methods.
		2017 Vol. 26 (6): 437-442 [Abstract] ( 1035 ) [HTML 1KB] [ PDF 1147KB] ( 3088 )

	443	linical significance of discordant T waves in lead aVR for predicting cardiovascular death
		ZHANG Yu-Zhong, ZHANG Jian-Yi
		Abnormal T waves are commonly seen in ECGs of healthy people, however the clinical significance of discordant T wave in lead aVR and its relationship with cardiovascular diseases has not been found. In America and Finland, the risk of cardiovascular death among healthy people with discordant T waves in lead aVR is 5 times higher than those with concordant T waves. For the patients with coronary heart disease(CHD) and old myocardial infarction(OMI), the incidence of cardiac endpoint events significantly increases among those with discordant T waves in lead aVR. For the patients with anterior OMI complicated by discordant T waves in lead aVR,hemodynamic changes are worsened. For CHD patients with ischemic cardiomyopathy, discordant T waves in lead aVR is closely related to sudden cardiac arrest and the incidence of sudden cardiac arrest is significantly higher than those with concordant T waves. The electrophysiological phenomenon of discordant T waves in lead aVR plays an important role in predicting the poor prognosis of the patients with potential cardiomyopathy and those with chronic kidney disease undergoing renal dialysis. It is also clinically valuable in making differential diagnosis between stress cardiomyopathy and acute myocardial infarction. The physiopathologic mechanism of discordant T waves in lead aVR is related to various factors including left cardiac insufficiency, increased ventricular wall stress, abnormal myocardial motion after myocardial infarction, and repolarization abnormality caused by denervation of myocardium after myocardial infarction.
		2017 Vol. 26 (6): 443-449 [Abstract] ( 1037 ) [HTML 1KB] [ PDF 1154KB] ( 1563 )

	450
		SHI Su-Qin, PAN Ling-Li

		2017 Vol. 26 (6): 450-452 [Abstract] ( 637 ) [HTML 1KB] [ PDF 3769KB] ( 1286 )

	453
		CHEN Xin, HU Wei-Guo

		2017 Vol. 26 (6): 453-455 [Abstract] ( 568 ) [HTML 1KB] [ PDF 1909KB] ( 1255 )

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