JOURNAL OF PRACTICAL ELECTROCARDIOLOGY

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JOURNAL OF PRACTICAL ELECTROCARDIOLOGY

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JOURNAL OF PRACTICAL ELECTROCARDIOLOGY

	2020 Vol.29 Issue.4 Published 2020-08-28

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		2020 Vol. 29 (4): 1-1 [Abstract] ( 31 ) [HTML 1KB] [ PDF 90708KB] ( 486 )

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		2020 Vol. 29 (4): 225-225 [Abstract] ( 37 ) [HTML 1KB] [ PDF 1888KB] ( 635 )

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		2020 Vol. 29 (4): 226-228 [Abstract] ( 38 ) [HTML 1KB] [ PDF 804KB] ( 757 )

	229	Analytical strategies of three-dimensional Lorenz scatter plot

		Objective To explore the analytical skills and strategies of three-dimensional Lorenz scatter plot. Methods Mathematical model of threedimensional Lorenz scatter plot was made by using solid geometry software. Based on plane analytic geometry, spatial analytic geometry, graph theory, and permutation and combination, the spatial distribution rules of threedimensional Lorenz scatter plot were studied; its characteristics and analytical skills were summarized, in a combination with typical cases with frequent ventricular premature beats, and their bigeminy and trigeminy(DMS Company). Results The three-dimensional Lorenz scatter plots of frequent ventricular premature beats, and their bigeminy and trigeminy reflect extremely strong regularity. The xOy and yOz surfaces are equivalent of two-dimensional Lorenz scatter plots, which reflect the rules of adjacent RR intervals. The zOx surface expresses extremely strong regularity of separated RR intervals, which exhibits symmetric features. The xyz surface is similar to two-dimensional difference scatter plot, which expresses the regularity of difference of adjacent RR intervals. And the surface centered at spatial constant velocity line satisfies the law of vector conservation. Conclusion The threedimensional Lorenz scatter plot integrates all the advantages of two-dimensional Lorenz scatter plot and two-dimensional difference scatter plot. It also facilitates the research on the regularity of separated RR intervals by providing a new perspective of zOx surface. The analytical strategies of three-dimensional Lorenz scatter plot are as follows. For the xOy and yOz surfaces, three-impulseandtwo-interval point is supplemented into four-impulseandthree-interval point separately in the methods of “add cardiac impulse in back” and “add cardiac impulse in front” based on two-dimensional Lorenz scatter plot. In the zOx surface, the classification characteristics of RR intervals can be known by its symmetric features. In the xyz surface, arrhythmia events can be analyzed on the basis of vector conservation.
		2020 Vol. 29 (4): 229-237 [Abstract] ( 98 ) [HTML 1KB] [ PDF 9375KB] ( 1393 )

	238	Fine analysis of three-dimensional Lorenz scatter plot: premature beats

		This paper selects three typical cases, starting with two-dimensional time scatter plot, Lorenz scatter plot and difference scatter plot, the regularity of threedimensional Lorenz scatter plot was explored step by step. The three-dimensional Lorenz scatter plot characteristics of atrial premature beats, atrial premature beats not conducting down, premature ventricular contraction, interpolated premature ventricular contraction and ventricular reciprocal beats were analyzed and summarized. The internal relations between two-dimensional Lorenz scatter plot, difference scatter plot and three-dimensional Lorenz scatter plot were compared. The results show that three-dimensional Lorenz scatter plot integrates all the advantages of two-dimensional Lorenz scatter plot and twodimensional difference scatter plot. A newly provided zOx surface exhibits symmetrical features(symmetry for constant velocity line). This reflects the regularity of separated RR intervals and the classification of RR intervals is exhibited in the most beautiful way. This is a new function that all of two-dimensional Lorenz scatter plots do not have. Another important theoretical significance of threedimensional Lorenz scatter plot is the verification of the important values of twodimensional difference scatter plot—the latter is equivalent of xyz surface of the former.
		2020 Vol. 29 (4): 238-246 [Abstract] ( 103 ) [HTML 1KB] [ PDF 31823KB] ( 685 )

	247	Joint use of three kinds of ECG scatter plots in rapid analysis of special complex arrhythmia

		Objective To explore the advantages of the joint use of three kinds of ECG scatter plots in rapidly analyzing special complex arrhythmias , and to accumulate experience of complex arrhythmia analysis. Methods Taking special atrial parasystolic rhythm as an example, its time scatter plot, Lorenz scatter plot and difference scatter plot were separately observed. Based on a combination of reversal technique and mathematical model of scatter plot, the characteristics of cardiac cycle, and features and formation principle of ECG scatter plot were analyzed. The electrophysiological significance reflected by ECG scatter plot was analyzed and summarized which helps to identify the nature of arrhythmias. ResultsThe three kinds of ECG scatter plots have their own characteristics. Time scatter plot: it is sometimes divided into two layers and sometimes divided into three layers. Within the time period corresponding to two layers, the scatter plot is presented as atrial bigeminy(the bottom layer is NS, and the top layer is SN) while atrial rhythm dominates the time period corresponding to three layers(layer SS is basically located in the middle of layer NS and SN). It implies that the compensatory interval added to coupling interval is equal to twice of the atrial rhythm cycle, that is, SN+NS=2SS. Lorenz scatter plot: the pink point set shows to be dominant(accounting for 2/3 of the total heart beats), and distributes neighboring to the shortlong period zone and constant velocity line. The blue point set is disadvantaged(accounting for 1/3 of the total heart beats), and distributes neighboring to the longshort period zone and constant velocity line. Mathematical model reveals that the pink point set embraces three overlapping components and no other obvious characteristic is found. Difference scatter plot: it is similar to make a 180° clockwise rotation of the difference scatter plot of bigeminy and trigeminy of frequent premature ventricular contraction with distinctive features. From a macroscopic view of scatter plot, atrial rhythm occupies a predominant position since its self-discipline reaches or is slightly over that of sinus rhythm. In the occurrence of intermittent efferent block, sinus rhythm appears in the form of escape beats without disrupting the rhythm. It suggests that there is protective afferent block in atrial rhythm of this example, and it is atrial parasystolic rhythm with increased self-discipline. Conclusion The joint use of three kinds of ECG scatter plots provides a macroscopic view for analyzing special complex cases. The electrophysiological significance revealed by scatter plot serves as references for defining the nature of arrhythmia. The joint use of three kinds of ECG scatter plots has obvious advantages in the rapid analysis of complex arrhythmia.
		2020 Vol. 29 (4): 247-252 [Abstract] ( 98 ) [HTML 1KB] [ PDF 13091KB] ( 733 )

	253	Application and advances of self-help mode of wearable mobile ECG monitoring devices

		Medical wearable devices have access to consumer markets, and doctors also have been using wearable mobile ECG monitoring to help outofhospital patients to record ECGs. Multiple selfhelp modes of wearable mobile ECG monitoring are gradually used by outofhospital natural population to monitor whether the frequency of heart beats and cardiac rhythm are normal or not, and the necessity of visiting a doctor. Findings of screening for atrial fibrillation were released, and verified the clinical significance of remote mobile ECG monitoring. With the progress of technology, the newly developed multimodal cardiopulmonary monitoring equipment is anticipated to realize the family care for chronic and rehabilitation patients.
		2020 Vol. 29 (4): 253-255 [Abstract] ( 97 ) [HTML 1KB] [ PDF 919KB] ( 1296 )

	256	Analysis of user’s ECG data recorded and uploaded by remote ECG monitoring smartphone

		Objective To analyze user's ECG data recorded and uploaded by remote ECG monitoring smartphone in natural population, and to compare the diagnostic effects between intelligent analysis and artificial diagnosis. Methods Smart handheld ECG measuring equipment was used in our study. A total of 9259 volunteers in 11 cities of Shanxi province were enrolled, among whom were 3872 males and 5387 females at an average age of (42.7±18.9) years old. A total of 12 109 ECGs were obtained. Results(i) In the artificial diagnosis method, 602 abnormal ECGs are identified with a detection rate of 65%; by using intelligent analysis software, 1296 abnormal ECGs are identified with a detection rate of 14.0%, and the difference is of statistical significance(P<0.005). (ii) Tachyarrhythmia is detected in 277 cases(46.0%) while atrial fibrillation is detected in 30 cases(5.0%). (iii) By using intelligent analysis software, 10 789 ECGs are correctly diagnosed, and its coincidence rate with artificial diagnosis is 89.1%. Among the 1320 misdiagnosed ECGs, there are 1213 cases(91.9%) caused by interference fluctuations. Conclusion By making intelligent analysis of user's ECGs recorded and uploaded by handheld singlelead ECG equipment, arrhythmias can be identified, and atrial fibrillation can be detected. The coincidence rate of autodiagnosis by intelligent software is tolerable, but it still requires for further enhancement of abilities of interference identification.
		2020 Vol. 29 (4): 256-258 [Abstract] ( 85 ) [HTML 1KB] [ PDF 886KB] ( 960 )

	259	Questionnaire analysis of remote portable mobile ECG monitoring among outpatients

		Objective To investigate the knowledge and attitude to remote portable mobile ECG monitoring in natural population, and to analyze the feasibility of performing remote ECG monitoring. Methods Investigation was carried out in 11 cities of Shanxi province, and 6503 persons accepted questionnaire survey. Results (i) The questionnaire survey reveals that 2900 subjects(47.9%) in the investigated population have undergone ECG examination, and they are older than those who have not accepted ECG testing[(48.2±16.9) years old vs. (41.7±17.8) years old, P<0.01]. (ii) There are 701 subjects(11.4%) who have known of mobile ECG monitoring equipment and its capability of remote diagnosis, and they are younger than those who have not known of the equipment\[(38.3±17.4) years old vs. (45.6±17.5) years old, P<0.01]. (iii) Subjects who are willing to conduct free remote ECG monitoring account for 91.9%. (iv) Only 1.8% of the research objects are willing to accept remote ECG monitoring at their own expense. Cost less than 60 yuan can be accepted by 66.0% of the population while only 63% are ready to pay more than 300 yuan. ConclusionThe awareness rate about portable mobile ECG monitoring equipment and remote ECG diagnosis is low among the natural population of Shanxi province, and thus it requires for enhanced propaganda. The vast majority of them are willing to be examined freely, most of them are willing to pay less than 60 yuan, and a minority of them are ready to pay more than 300 yuan.
		2020 Vol. 29 (4): 259-261 [Abstract] ( 70 ) [HTML 1KB] [ PDF 886KB] ( 880 )

	262	Research of ECG diagnosis based on machine learning

		Electrocardiogram(ECG) plays an irreplaceable role in the diagnosis of cardiovascular diseases, and machine learning shows a unique advantage in the automation of ECG diagnosis. A total of 21 837 ECG records in the public ECG database PTB-XL were used. The ECG data were preprocessed by deleting missing values, clipping and removing baseline before extracting their relevant features by principal component analysis. Classification research was carried out using K-nearest neighbor, random forest, Logistic regression and support vector machine(SVM) algorithms, and the performances of the four algorithms were compared and analyzed according to the research results. The results show that the SVM algorithm is obviously superior to the other three classification algorithms in aspects of model evaluation indicators including accuracy rate, recall rate, precision rate, and area under curve(AUC).
		2020 Vol. 29 (4): 262-268 [Abstract] ( 90 ) [HTML 1KB] [ PDF 6756KB] ( 1736 )

	269	Comparative analysis of two diagnostic criteria for pure left anterior fascicular block based on ECG data cloud platform

		Objective To compare the detection rate, sensitivity and specificity of two diagnostic criteria in the diagnosis of left anterior fascicular block(LAFB). The two diagnostic criteria were separately proposed in a book named “Clinical arrhythmology” and “2019 AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram”, namely diagnostic criterion 1 and 2, respectively. Methods A retrospective study was carried out on routine ECGs with QRS axis between －45° and －90° in our hospital. Those individuals with inferior and lateral wall myocardial infarction, ventricular preexcitation, complete right bundle branch block, and ventricular hypertrophy were excluded. Taking vectorcardiogram(VCG) diagnostic criterion as a standard, the detection rate, sensitivity and specificity of the two ECG diagnostic methods for LAFB were analyzed. Results A total of 3503 cases are involved from which VCG detects 1137 cases(32.46%), diagnostic criterion 1 detects 1376 cases(39.28%), and diagnostic criterion 2 detects 2431 cases(69.40%). The sensitivity and specificity of diagnostic criterion 1 are separately 59.37% and 70.37% while those of diagnostic criterion 2 are 87.25% and 39.18%, respectively. The specificity of diagnostic criterion 1 is significantly higher than that of diagnostic criterion 2(P＜0.05), however, the detection rate and sensitivity of the latter is significantly higher(P＜0.05). Conclusion The diagnostic criterion 2 is more suitable for pure LAFB screening because of its higher detection rate and sensitivity.
		2020 Vol. 29 (4): 269-272 [Abstract] ( 85 ) [HTML 1KB] [ PDF 908KB] ( 886 )

	273	Comparison of three ECG detection methods in the diagnosis of senile coronary heart disease

		Objective To compare and analyze the value of routine electrocardiogram(ECG), ambulatory electrocardiography(AECG) and treadmill exercise test(TET) in the diagnosis of senile coronary heart disease(CHD). Methods A total of 120 elderly patients suspected with CHD who had been examined in our outpatient department were selected as research objects. All patients underwent routine ECG, AECG and TET examinations; finally coronary angiograph(CAG) diagnosis was taken as the standard to evaluate and analyze the diagnostic value of the three examination methods for senile CHD. ResultsAmong the 120 suspected CHD patients, 86 cases are confirmed by CAG, including 30 cases with mild coronary artery stenosis, 45 cases with moderate stenosis and 11 cases with severe stenosis, or 33 cases with single vessel lesions and 53 cases with multivessel lesions. In the 86 patients diagnosed with CHD, the detection rates of AECG and TET for CHD (75.6% and 79.1%, respectively) are significantly higher than that of routine ECG(60.5%,P<0.05); the detection rates of AECG and TET for mild stenosis and severe stenosis, and single vessel and multi-vessel lesions are significantly higher than those of routine ECG(P<0.05). The detection rate of any of the three detection methods for multi-vessel lesions is significantly higher than that for single vessel lesions(P<0.05). The sensitivity and accuracy of AECG and TET in the diagnosis of CHD are significantly higher than those of routine ECG(P<0.05). ConclusionRoutine ECG, AECG and TET are valuable in diagnosing senile CHD. A combination of the three methods may help to improve the diagnostic rate and reduce the misdiagnosis rate of CHD.
		2020 Vol. 29 (4): 273-275 [Abstract] ( 94 ) [HTML 1KB] [ PDF 953KB] ( 788 )

	276	Clinical significance of interatrial block in surface ECGs of patients with paroxysmal atrial fibrillation

		Objective To investigate the occurrence and clinical significance of interatrial block (IAB) in surface ECGs of patients with paroxysmal atrial fibrillation(PAF). MethodsData of 287 patients with PAF and 133 patients as non-PAF controls in our hospital were collected. The clinical characteristics, cardiac echocardiographic indicators, and incidences of incomplete IAB(p-IAB) and high-degree IAB(a-IAB) were compared between the two groups. ResultsThe incidence of IAB in the PAF group is significantly higher than that in the control group(p-IAB: 39.4% vs. 28.3%; a-IAB: 24.4% vs. 8.3%, P<0.01). Correlation analysis shows a positive correlation between IAB and PAF(r=0.297, P<0.01). Logistics analysis shows that IAB is an independent related factor of PAF(OR=2.443, 95%CI:1.659-3.596; P<0.01). ConclusionThe incidence of IAB is higher in patients with PAF and IAB is an independent factor related to PAF. IAB analysis based on surface ECG can be considered as a clinical screening method for PAF.
		2020 Vol. 29 (4): 276-279 [Abstract] ( 79 ) [HTML 1KB] [ PDF 948KB] ( 1156 )

	280	Effect and mechanism of n-3 polyunsaturated fatty acids on atrial fibrillation

		As bioactive compounds, n-3 polyunsaturated fatty acids(n-3 PUFAs) contribute to human health through lowering serum triglyceride, and regulating heart rate and blood pressure. They also have potential anti-arrhythmia effect. Atrial fibrillation(AF) is the most commonlyseen sustained arrhythmia, which could lead to changes in atrial structure and function. In recent years, many studies have shown that n-3 PUFAs can affect the physicochemical properties of myocardial cell membranes, regulate the interaction of membrane channel proteins and the expression of transcription factors, and thus influence the electrophysiological characteristics of myocardial cells. Additionally, n-3 PUFAs play a direct or indirect anti-AF role by regulating the function of ion channels in the cell membranes and thus reducing atrial electrical remodeling.
		2020 Vol. 29 (4): 280-284 [Abstract] ( 98 ) [HTML 1KB] [ PDF 980KB] ( 883 )

	285	Clinical advances of neuromodulation for treatment of ventricular arrhythmias

		Autonomic dysregulation plays an important role in the pathogenesis of ventricular arrhythmias. Neural feedback loop of different levels links heart and the nerve center. Cardiac disease leads to cardiac neural remodeling and autonomic dysregulation, which could regulate cardiac electrical activities at the autonomic nervous center and peripheral levels. This review discusses the recent applied research advances in neuromodulation techniques for refractory ventricular arrhythmias caused by hereditary and structural heart diseases. It aims to promote basic research of neurocardiology to adapt to the needs of clinical practice.
		2020 Vol. 29 (4): 285-289 [Abstract] ( 79 ) [HTML 1KB] [ PDF 953KB] ( 1060 )

	290	Influence of cryoballoon ablation of atrial fibrillation on the occurrence of silent cerebral embolism

		Currently, cryoballoon ablation has been a new technique for treating atrial fibrillation. A large number of clinical researches have confirmed its efficacy and safety in the treatment of atrial fibrillation, but there is still a relatively high incidence of silent cerebral embolism. Although several studies have suggested that silent cerebral embolism has a slight impact on the nervous system, however, some studies have also found that it can affect the function of speech and memory. Some scholars even believe that silent cerebral embolism may have longterm adverse effects on the nervous system. In this review, the effects of cryoballoon ablation on the occurrence of silent cerebal embolism are discussed from the aspects of pathogenesis, risk factors, clinical manifestations, prevention and treatment strategies.
		2020 Vol. 29 (4): 290-294 [Abstract] ( 87 ) [HTML 1KB] [ PDF 943KB] ( 1020 )

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		2020 Vol. 29 (4): 295-297 [Abstract] ( 70 ) [HTML 1KB] [ PDF 2193KB] ( 858 )

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		2020 Vol. 29 (4): 298-299 [Abstract] ( 83 ) [HTML 1KB] [ PDF 6555KB] ( 1355 )

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		2020 Vol. 29 (4): 300-301 [Abstract] ( 56 ) [HTML 1KB] [ PDF 7231KB] ( 1195 )

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		2020 Vol. 29 (4): 302-304 [Abstract] ( 84 ) [HTML 1KB] [ PDF 11106KB] ( 660 )

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