JOURNAL OF PRACTICAL ELECTROCARDIOLOGY

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JOURNAL OF PRACTICAL ELECTROCARDIOLOGY

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JOURNAL OF PRACTICAL ELECTROCARDIOLOGY

	2020 Vol.29 Issue.5 Published 2020-10-28

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		2020 Vol. 29 (5): 1-1 [Abstract] ( 28 ) [HTML 1KB] [ PDF 67174KB] ( 554 )

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		2020 Vol. 29 (5): 303- [Abstract] ( 51 ) [HTML 1KB] [ PDF 170KB] ( 662 )

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		2020 Vol. 29 (5): 304- [Abstract] ( 40 ) [HTML 1KB] [ PDF 316KB] ( 677 )

	305	Relevant factor analysis of acute myocardial infarction complicated by acute heart failure
		Yao Huiqiang, Zhang Xianlin
		Objective To retrospectively analyze the relevant factors of acute myocardial infarction(AMI) complicated with acute heart failure(HF). Methods A total of 204 AMI patients treated in our hospital were selected as research objects. According to the Killip cardiac function classification of HF after AMI, they were divided into HF group(n=68) and non-HF group(NHF group, n=136). Based on clinical data and results of coronary angiography, the incidence of early HF after AMI in hospital and fundamental influencing factors of prognosis were analyzed. Logistic regression analysis was utilized to explore the risk and protective factors of early HF in AMI patients. Results There exist statistically significant differences of age, number of diseased coronary arteries, infarctionrelated vessels, neutrophils to lymphocytes ratio(NLR), brain natriuretic peptide(BNP) and albumin between HF and NHF groups(P<0.05). Age, lesions of anterior descending branch, NLR and BNP are risk factors of HF while albumin is a protective factor of HF. Conclusion High NLR and BNP level, older age, and lesions of anterior descending branch can predict acute HF in patients with AMI.
		2020 Vol. 29 (5): 305-308 [Abstract] ( 93 ) [HTML 1KB] [ PDF 928KB] ( 887 )

	309	Changes and clinical significance of ambulatory electrocardiography in climacteric women
		Wang Rehua
		Objective To study the changes and clinical significance of ambulatory electrocardiography(AECG) in climacteric women. Methods A total of 120 menopausal women were selected and included in the observation group while in the control group were 100 male subjects of the same age group. The AECG detection results were compared between the two groups. Results The positive rate of ST-T segment change in the observation group is 35.00%, which is significantly higher than 2.00% in the control group(χ²=37.125,P<0.05). In the observation group, heart rates of the patients with and without ST-T segment changes were (76.65±5.71) beats/min and (78.05±4.08) beats/min, respectively, and there is no statistically significant difference in data comparison (t=1.553, P>0.05); there is no significant difference in heart rate variability among menopausal females of varying symptom severity(P>0.05); there is no significant difference in the incidence of ST-T segment changes among the menopausal women aged 45-49, 50-54 and 55-59(F=0.854, P>0.05); propranolol test shows that ST-T segment depression returned to normal in 71.43% of patients. Conclusion AECG changes of climacteric women are mainly functional, which requires to be paid more attention and actively treated in the process of clinical diagnosis and treatment.
		2020 Vol. 29 (5): 309-312 [Abstract] ( 81 ) [HTML 1KB] [ PDF 856KB] ( 907 )

	313	Clinical value of heart rate variability and echocardiography on heart failure patients with preserved ejection fraction
		Xu Liangjie, Wang Chunliang, Zhou Cuicui, Liang Yi
		Objective To explore the clinical value of heart rate variability(HRV) and echocardiography in making diagnosis and prognostic evaluation among heart failure patients with preserved ejection fraction. Methods A total of 144 patients with normal left ventricular ejection fraction(LVEF) underwent 24hour ambulatory electrocardiography and routine echocardiography examinations. Patients were divided into two groups according to echocardiography results: left ventricular diastolic dysfunction(LVDD) group(LVDD group, 76 cases) and normal left ventricular diastolic function(LVDF) group(normal LVDF group, 68 cases). According to the receiver operating characteristic(ROC) curve, the diagnostic significance of HRV on LVDD was analyzed, and the primary endpoint events were followed up. Results Among HRV indexes, the area under curve of 24-hour standard deviation of NN intervals(SDNN) in the prediction of LVDD is the largest (AUC=0.827，P<0.01); the cut-off value is 92 ms. According to the cut-off value, the patients in LVDD group are further divided into two groups: low-SDNN group(cut-off value<92 ms, 40 cases) and high-SDNN group (cut-off value≥92 ms, 36 cases). The survival curve reveals that in the low-SDNN group the incidence of adverse cardiac events and total mortality are significantly higher than those in the high-SDNN group(P<0.05). Conclusion SDNN can be served as a sensitive indicator for making clinical diagnosis and prognostic evaluation among the patients with LVDD.
		2020 Vol. 29 (5): 313-318 [Abstract] ( 102 ) [HTML 1KB] [ PDF 2153KB] ( 868 )

	319	Correlation between ECG characteristics and prognosis of early repolarization syndrome in community physical examination population
		Liu Mei1, Chen Wang, Liu Zhonglong, Liu Zhigang, Zeng Ling, Pan Juanfang, Zhang Jian, Xi Yichao
		Objective To study the relationship between electrocardiogram(ECG) characteristics and prognosis of early repolarization syndrome(ERS) among community physical examination population. Methods A community population of 6 612 was enrolled in our study. These research objects were aged between 18 and 75 years old with complete ECG and clinical data in the remote ECG examination in Binhu Hospital of Hefei City. The patients were diagnosed and classified according to the ECG diagnostic criteria of ERS; their biochemical indicators and clinical data were recorded. Results There are 185 cases with ERS(2.8%) and 6 427 cases without ERS; in the ERS group, the average heart rate is significantly lower than that in the non-ERS group while QT interval and QTc are both significantly prolonged(P＜0.05). ERS subgroup analysis indicates that QT interval of the population with amaurosis history is significantly longer than that of the population without amaurosis history(P＜0.05). There is statistically significant differences between the two groups in aspects of sex, history of smoking, history of amaurosis, body mass index, history of coronary heart disease, diabetes and cerebral infarction, and total cholesterol and high density lipoprotein(P＜0.05). Regression analysis suggests that heart rate, PQ interval, QRS duration, QT interval and QTc are risk factors for ERS (P＜0.05); age, sex, and histories of hypertension, diabetes and coronary heart disease are not risk factors for ERS(P＞0.05). Conclusion Among the ERS patients in the community physical examination population, the heart rate is significantly slower, and QT and QTc intervals are significantly prolonged; the incidence of amaurosis significantly increases which is apparently correlated with QT interval. P-wave duration, PQ interval, QRS duration, and QT interval and QTc may be risk factors for ERS.
		2020 Vol. 29 (5): 319-323 [Abstract] ( 59 ) [HTML 1KB] [ PDF 891KB] ( 919 )

	324	Predictive value of abnormal P-wave duration indexes on paroxysmal atrial fibrillation
		Fang Xu, Wang Jun, Yang Jimeng, Shi Peiqing, Dong Haicui, Zhang Yuqing
		Objective To explore the value of abnormality of P-wave duration indexes in routine 12-lead simultaneous ECG in predicting paroxysmal atrial fibrillation(PAF). Methods A total of 100 outpatients and inpatients with PAF in our hospital were selected as research objects(AF group) while 80 cases who had taken health examination with normal sinus rhythm were selected as control group. The P-wave dispersion(PWD) and the maximum duration of P-wave in routine 12-lead simultaneous ECG were measured and compared between the two groups. Results PWD of the patients in the AF group is significantly higher than that in the control group[(51.08±12.03) ms vs. (33.19±8.98) ms], and the maximum P-wave duration is also significantly higher than that in the control group[(121.57±15.33) vs. (101.94±9.89)], both with statistically significant differences(P<0.05). Conclusion By measuring P-wave indexes in routine 12-lead simultaneous ECG, patients with PAF can be screened early. Early diagnosis and treatment help to reduce the incidence of stroke among this kind of population.
		2020 Vol. 29 (5): 324-326 [Abstract] ( 82 ) [HTML 1KB] [ PDF 849KB] ( 711 )

	327	Vectorcardiogram analysis of hypertension complicated by left ventricular hypertrophy
		Xiong Tianzhen, Long Youling, Liu Ming, Li Ying, Dai Jing
		Objective To explore the clinical value of vectorcardiogram (VCG) in the diagnosis of left ventricular hypertrophy(LVH). Methods A total of 94 hypertensive patients with LVH diagnosed by VCG were enrolled in our study, and their cardiac ultrasound and related clinical data were retrospectively analyzed. They were divided into normal group and LVH group (abnormal group) according to left ventricular weight index. The VCG and related clinical indexes were compared between the two groups. Results In the abnormal group, VCG indexes are higher than those in the normal group(P<0.05); those indexes include left direction force, transverse plane QRS loop voltage, frontal plane QRS loop voltage, QRS loop maximum space vector, QRS loop starting right vector voltage, QRS loop starting right forward vector voltage, T ring abnormality, QRS loop orientation, etc. The two groups are significantly varied in clinical indexes such as the duration of hypertension and regular use of antihypertensive drugs(P<0.05). However, there is no significant difference in the complicating of diabetes between the two groups(P>0.05). Conclusion VCG indicators including QRS loop starting vector, QRS loop voltage, T ring and QRS loop orientation have diagnostic value for LVH; long course of hypertension and irregular intake of antihypertensive drugs are important clinical factors for LVH.
		2020 Vol. 29 (5): 327-330 [Abstract] ( 61 ) [HTML 1KB] [ PDF 883KB] ( 877 )

	331	Clinical value of vectorcardiogram in diagnosis of complete right bundle branch block
		Huang Wen, Long Youling, Liu Ming, Dai Jing, Lu Xi
		Objective To investigate the clinical application value of vectorcardiogram(VCG) in the diagnosis of complete right bundle branch block(CRBBB). Methods A total of 134 patients with CRBBB diagnosed by VCG and ECG were selected and divided into normal cardiac structure group(normal group) and abnormal cardiac structure group(abnormal group) according to the results of cardiac echocardiography. The clinical data and VCG indexes were compared between the two groups. Results Comparison between the two groups reveals that indexes including the abnormal rate of T ring lengthwidth ratio, the abnormal rate of QRS loop voltage to T ring voltage ratio (R/T), QRS loop duration and QRS loop space maximum vector(QRS loop voltage) in the abnormal group are significantly higher than those in the normal group(P＜0.05). However, there is no significant difference in age, gender, body mass index(BMI), QRS loop operating direction and T ring voltage between the two groups(P>0.05). ConclusionT he clinical significance of CRBBB can be preliminarily evaluated combined with VCG analysis indexes.
		2020 Vol. 29 (5): 331-334 [Abstract] ( 88 ) [HTML 1KB] [ PDF 17538KB] ( 819 )

	335	Current situation analysis of specialist consultation in cardiovascular medicine department
		Song Xiaowu, Wang Jinli, Gao Ling, Dong Ying, Shi Yajun, Li Xin
		Objective To investigate the current situation of specialist consultation in cardiovascular medicine department, find out the existing problems, and to propose feasible measures to improve its quality. Methods The cardiovascular consultation application cases were selected from each clinical department of the PLA General Hospital. The electronic medical record management system(PRIDE system) of our hospital was used to obtain statistical data of online cardiovascular consultation applications. Those patients who had completed consultation within 48 hours were traced, and their basic information, ECG diagnosis and consultation purposes were collected. According to the original department before consultation application, the consultation cases were divided into four categories—surgical department, internal medicine department, emergency department and oncology department. Results A total of 583 consultations are selected, of which 393(67.4%) are surgical cases, 96 cases (16.5%) are from internal medicine department, 80 cases(13.7%) are from emergency department, and 14 cases(2.4%) are from oncology department. The top five departments ranked by consultation amount are department of orthopedics(93 cases, accounting for 16.0%), emergency department(79 cases, accounting for 13.6%), department of urinary surgery(58 cases, accounting for 9.9%), department of general surgery(54 cases, accounting for 9.3%) and department of hepatobiliary surgery(52 cases, accounting for 8.9%) in turn. Specialist consultations for nonemergency inpatients are mainly out of the purposes of diagnosis and treatment assistance(42.7%), simple ECG abnormality diagnosis(27.4%), routine preoperation consultation(15.7%), and diagnosis and treatment of original and suspected heart diseases(14.1%). The main consultation purpose of the emergency department cases is the diagnosis and treatment of original and suspected heart diseases. Among those consultation cases due to ECG abnormalities, except for two or more ECG abnormalities, the proportion of T-wave changes is the highest, accounting for 15.1%, followed by sinus arrhythmia accounting for 11.5%. Conclusion Specialist consultation in cardiovascular medicine department is in great demand, but actually necessary professional consultation only accounts for a minor part of it. It requires for further study on the possibility of reducing the amount of procedural consultations in the future.
		2020 Vol. 29 (5): 335-339 [Abstract] ( 72 ) [HTML 1KB] [ PDF 965KB] ( 1038 )

	340	Exploration of ECG teaching reform in colleges and universities of traditional Chinese medicine aiming at improving students’ clinical practice ability
		Sun Jinghe, Zhang Jin, He Xiaolian，Xie Huiwen
		Objective Aiming at improving students’ clinical practice ability, practical teaching segment has been introduced into the process of ECG teaching in colleges and universities of traditional Chinese medicine(TCM). To investigate its teaching effect and application value if compared with traditional teaching mode. Methods The undergraduate classes of 2025 and 2024 in our college were taken as research objects who were randomly divided into experimental group(undergraduate class of 2025, 89 cases) and control group(undergraduate class of 2024, 90 cases). Traditional plus practice mode of teaching was used in the experimental group while traditional teaching mode was applied in the control group. Unified assessment was performed on the two groups of students after teaching. The teaching effect in the two teaching modes was evaluated by questionnaire and made objective comparison. Results The scores of classroom test and final examination of the experimental group are (96.12±3.34) and (17.22±3.81) respectively, significantly higher than those of the control group; the difference between the two groups is statistically significant(P<0.01). The teaching effect of the experimental group is significantly better than that of the control group with statistically significant difference(P<0.01). Conclusion Aiming at improving students’ clinical practice ability, the introduction of practical teaching segment into the process of ECG teaching in TCM colleges and universities can significantly improve the scores of ECG theoretical examination, and the capability of clinical diagnosis and analysis of ECG, which significantly improves the teaching effect. It is worthy of further promotion and application.
		2020 Vol. 29 (5): 340-343 [Abstract] ( 76 ) [HTML 1KB] [ PDF 864KB] ( 730 )

	344	Applications of mathematical tools in solving the problem of atrial flutter waveform fusion
		Li Yi, Yuan Jie, Tao Liang
		Flutter wave is often fused with QRS complex and ST-T segment in the occurrence of atrial flutter, which affects the accuracy of measured ECG interval and amplitude. Mathematical tools and thinking are particularly important in the integration of electrocardiographic waves and data. In this paper, Matlab is used to extract the coordinates of the target ECG, the original coordinate data are edited and modified based on the electrophysiological characteristics of atrial flutter, and then the processed coordinates are refitted as new ECG waves. The morphology of QRS complex and ST-T segment without superposing atrial flutter wave is attempted to be restored.
		2020 Vol. 29 (5): 344-347 [Abstract] ( 82 ) [HTML 1KB] [ PDF 4501KB] ( 957 )

	348	Rotor mechanism and its mapping in atrial fibrillation
		Qin Mu, Liu Tao, Liu Xu
		Treatment of atrial fibrillation(AF) remains challenging despite a deep understanding of its underlying mechanisms. The detailed and quantitative description of functional reentry, the famous “leading circle” model, was developed more than 40 years ago. Subsequently, an alternative paradigm based on spiral waves has long been postulated to drive AF in decades of study. Rotor as a “spiral wave generator”, is a curved “vortex” formed by spin motion in the twodimensional plane, which can be identified by using advanced mapping methods in experimental and clinical AF. However, it is difficult to achieve complementary results between basic results and clinical studies due to limited research methods and complexity of rotor mechanism. This paper reviews knowledge garnered over decades on generation, electrophysiological properties and threedimensional structure diversity of the rotor, and make a comparison among the latest clinical approaches of rotor identification, such as panoramic mapping and local highdensity mapping. Although the rotor mapping and ablation perform as a promising therapeutic option for AF, some inclusive outcomes of studies remain existing in either panoramic mapping or local high-density mapping. It is proposed that the clinical rotor identification might be substantially influenced by (ⅰ) non-identical surface activation patterns resulted from diverse threedimensional forms of scroll wave, and (ⅱ) inadequate resolution of mapping techniques. With rapidly advancing theoretical and technological developments, future work is required to resolve the clinical limitations in current basic and clinical research methodology, in translation from one to the other, and in resolution of available mapping techniques.
		2020 Vol. 29 (5): 348-355 [Abstract] ( 113 ) [HTML 1KB] [ PDF 6801KB] ( 989 )

	356	Exploration of physiological electrical conduction of ventricular pacing:His bundle pacing and left bundle branch pacing
		Zhai Xinkun, Chen Xiaodong
		The electrical synchronization after ventricular pacing is the target of physiological pacing. Longterm right ventricular apex pacing can increase the incidence rate of atrial fibrillation, heart failure and so on. Cardiac resynchronization therapy can improve the cardiac synchronization between the left and right ventricles. But there is still a 20 to 35 percent of nonresponse rate in clinical use, and the electrical synchronization after pacing differs from that of normal electrical conduction. His bundle pacing (HBP) is the real physiological pacing because of the pacing excitation point in His bundle and electrical excitation along HisPurkinje system. However, there are some difficulties in the clinical practice of HBP, such as low success rate in procedures, high pacing threshold, difficulties in electrode location and fixation, poor sensing of the ventricle, and so on. Left bundle branch pacing (LBBP) is a new pacing concept proposed in recent years, which aims to achieve a balance between electrical synchronization after pacing and the efficiency and safty of clinical operation. But there is not enough proof from largescale clinical studies supporting its indications and safty. This review interprets the theoretical basis, recent development, advantages, and problems of HBP and LBBP in the aspect of physiological electrical synchronization.
		2020 Vol. 29 (5): 356-362 [Abstract] ( 68 ) [HTML 1KB] [ PDF 5145KB] ( 1265 )

	363	Advances in relativity between electrocardiographic markers of atrial cardiomypathy and cryptogenic stroke
		She Piaopiao, Wang Deguo
		About one third of ischemic strokes have no defined etiology, which is classified as cryptogenic stroke. It was supposed that subclinical atrial fibrillation(AF) may be related with cryptogenic stroke. Prolongation of ECG monitoring time helps to detect covert AF. However, recent studies suggested that some patients with obvious atrial structural changes and functional abnormalities are prone to suffer from atrial thromboembolism regardless of the presence of AF. These abnormal alterations of atrial substrate may show up in ECGs and become a diagnostic clue for atrial cardiomyopathy. This article reviews the advances in the relativity between electrocardiographic markers of atrial cardiomypathy and cryptogenic stroke.
		2020 Vol. 29 (5): 363-366 [Abstract] ( 75 ) [HTML 1KB] [ PDF 885KB] ( 803 )

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		2020 Vol. 29 (5): 367-369 [Abstract] ( 84 ) [HTML 1KB] [ PDF 11534KB] ( 783 )

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		2020 Vol. 29 (5): 370-372 [Abstract] ( 63 ) [HTML 1KB] [ PDF 3298KB] ( 739 )

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		2020 Vol. 29 (5): 373-376 [Abstract] ( 81 ) [HTML 1KB] [ PDF 9424KB] ( 957 )

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		2020 Vol. 29 (5): 377-380 [Abstract] ( 71 ) [HTML 1KB] [ PDF 12269KB] ( 710 )

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		2020 Vol. 29 (5): 381-381 [Abstract] ( 41 ) [HTML 1KB] [ PDF 789KB] ( 757 )

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		2020 Vol. 29 (5): 382-382 [Abstract] ( 46 ) [HTML 1KB] [ PDF 790KB] ( 694 )

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		2020 Vol. 29 (5): 383-383 [Abstract] ( 44 ) [HTML 1KB] [ PDF 793KB] ( 634 )

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		2020 Vol. 29 (5): 384-384 [Abstract] ( 45 ) [HTML 1KB] [ PDF 551KB] ( 881 )

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