JOURNAL OF PRACTICAL ELECTROCARDIOLOGY

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JOURNAL OF PRACTICAL ELECTROCARDIOLOGY

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JOURNAL OF PRACTICAL ELECTROCARDIOLOGY

	2021 Vol.30 Issue.1 Published 2021-02-28

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		2021 Vol. 30 (1): 1-1 [Abstract] ( 25 ) [HTML 1KB] [ PDF 39019KB] ( 545 )

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		2021 Vol. 30 (1): 2-2 [Abstract] ( 27 ) [HTML 1KB] [ PDF 1869KB] ( 635 )

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		2021 Vol. 30 (1): 3-3 [Abstract] ( 28 ) [HTML 1KB] [ PDF 327KB] ( 567 )

	4	Impact of quantitative ablation on cardiac structure and function in patients with paroxysmal atrial fibrillation
		HU Mingsheng, WANG Xiaofei, ZOU Cao, WANG Wenli, LIN Jia, LI Xun
		Objective To investigate the changes of cardiac structure and function in patients with paroxysmal atrial fibrillation(PAF) after undergoing quantitative radiofrequency catheter ablation (RFCA). Methods We retrospectively analyzed the clinical data and postoperative followup data of 188 PAF patients after undergoing RFCA. All the subjects had been performed pointbypoint radiofrequency ablation, guided by the Visitag module of the Carto3 system in 64 cases and ablation index in 124 cases, respectively. The subjects were divided into recurrence group(n=31) and non-recurrence group (n=157). The recurrence of atrial fibrillation was defined as the appearance of rapid atrial arrhythmias including atrial tachycardia lasting over 30 s, atrial flutter and atrial fibrillation after a 3month blanking period. Echocardiography examination was utilized in measuring the atrial and ventricular diameter, and left ventricular systolic and diastolic function indexes before and 3 months after RFCA. Results (ⅰ) After an average followup period of (14.4±8.3) months, 83.5%(157/188) of patients maintained sinus rhythm. The success rate in PAF patients with the left atrial diameter (LAD)<40 mm and LAD≥40 mm is 89.1%(57/64) and 80.6%(100/124), respectively. (ⅱ) In the nonrecurrence group, LAD, the right atrial diameter (RAD) and bicuspid valve E wave velocity all significantly decrease after the operation (P<0.05). In the recurrence group, RAD significantly decreases while left ventricular ejection fraction (LVEF) significantly increases after the operation (P<0.05). There is no statistically significant difference of other indexes between the two groups. (ⅲ) Among the PAF patients with LAD≥40 mm, the indexes of LAD, RAD, LVEDD, LVESD,bicuspid valve E peak, and tricuspid regurgitation pressure are significantly higher than those PAF patients with LAD<40 mm before the ablation; LVEF is significantly reduced (P<0.05). Among the PAF patients with LAD<40 mm, RAD and bicuspid valve A peak significantly decrease after the ablation (P<0.05); among the PAF patients with LAD≥40 mm, LAD, RAD and bicuspid valve E peak decrease after the ablation while LVEF significantly increases (P<0.05). Conclusion The medium and longterm success rate of quantitative ablation is relatively high in PAF patients. Quantitative ablation could partially reverse both left and right atrial structural remodeling, and improve ventricular function.
		2021 Vol. 30 (1): 4-7 [Abstract] ( 46 ) [HTML 1KB] [ PDF 1011KB] ( 770 )

	8	Research progress on the relationship among ion channels, autonomic nervous system and atrioventricular nodal reentrant tachycardia
		ZHU Yuncai, CHEN Yang, LI Xiaoping
		Atrioventricular nodal reentrant tachycardia(AVNRT) is the most common paroxysmal supraventricular tachycardia in clinical practice. At present, dual atrioventricular nodal pathways or multipathways are regarded as the matrix of AVNRT, but its exact physiopathologic mechanism and anatomical location have not been elucidated yet. The success rate of radiofrequency ablation can reach as high 95% among AVNRT patients in recent years. The molecular heterogeneity and distributional difference of ion channels may contribute to the formation of dual atrioventricular nodal pathways. In addition, the atrioventricular node is under the dual domination of the extracardiac and intracardiac autonomic nerves; imbalance of autonomic nervous system plays an important role in the induction and maintenance of AVNRT. This paper mainly introduces the research advances in the relationship among ion channels, autonomic nervous system and AVNRT.
		2021 Vol. 30 (1): 8-12 [Abstract] ( 61 ) [HTML 1KB] [ PDF 2026KB] ( 806 )

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		2021 Vol. 30 (1): 13-17 [Abstract] ( 54 ) [HTML 1KB] [ PDF 8879KB] ( 645 )

	18	Location of conduction bundle pacing guided by anatomy of HisPurkinje conduction system
		JIANG Limeng, SU Lan, HUANG Weijian
		In recent years, HisPurkinje conduction system pacing has become a feasible alternative to traditional right ventricular pacing in patients with heart failure requiring for ventricular pacing. Operator is required to place the electrode accurately in the areas of His bundle or left bundle branch, and whether the pacing electrode can be successfully implanted depends to a large extent on the operators understanding of the anatomical distribution features of HisPurkinje conduction system and variability of cardiac structure. This review is aimed to analyze the anatomical characteristics of atrioventricular node, His bundle and the proximal left bundle branch, and the relationship between different anatomical structures of conduction system and the occurrence of conduction block, which serves as a reference for guiding HisPurkinje conduction system pacing.
		2021 Vol. 30 (1): 18-23 [Abstract] ( 54 ) [HTML 1KB] [ PDF 16445KB] ( 585 )

	24	Analysis on inducing factors of atrioventricular nodal reentrant tachycardia in transesophageal atrial pacing
		CHEN Hui, CHU Yonghan, KANG Rui, YANG Lihong, XU Jinyi
		Objective To investigate the factors of inducing atrioventricular nodal reentrant tachycardia (AVNRT) during transesophageal atrial pacing (TEAP) examination. Methods A total of 163 patients undergoing TEAP examination were randomly selected for retrospective study; AVNRT was induced by cardiac electrophysiological examination. However, AVNRT was induced by TEAP in 92 patients (observation group) while AVNRT or other arrhythmias failed to be induced in 71 patients (control group). Setting the basic pacing interval (S1S1 interval) as 600 ms, we measured PR interval and effective refractory period of atrioventricular node; given programmed atrial S1S2 stimulation or frequencyincreasing S1S1 stimulation, we also measured the longest SR interval (SR prolonged interval) and the longest S1S1 interval in atrioventricular Wenckebach conduction (Wenckebach cycle). Data of gender and age were recorded. The inducing factors of AVNRT were explored by univariate and multivariate analysis. Results Bivariate Logistic regression analysis verifies that gender (OR=0.252, P=0.030), SR prolonged interval (OR=1.052, P＜0.01) and Wenckebach cycle (OR=0.938, P＜0.01) are independent risk factors for AVNRT inducement with a prediction accuracy rate of 92.6%. Conclusion Gender, SR prolonged interval and Wenckebach cycle can be considered as predictive factors for inducing AVNRT during TEAP examination with high value in clinical practice.
		2021 Vol. 30 (1): 24-27 [Abstract] ( 71 ) [HTML 1KB] [ PDF 1582KB] ( 805 )

	28	Comparison of diagnostic value of ambulatory electrocardiography and esophageal electrophysiological examination on palpitation causes
		WANG Liying,WANG Xinkang
		Objective To compare the application value of ambulatory electrocardiography (AECG) and esophageal cardiac electrophysiological examination in the population with palpitation. Methods We selected patients who had undergone AECG and esophageal electrophysiological examination due to palpitation, separately 400 and 123 cases. The positive rate and detection rate of different types of arrhythmia were compared between the two examination methods. Results A total of 258 cases of arrhythmia (64.5%) are detected by AECG while 90 cases (73.2%) were detected by esophageal electrophysiological examination. The positive rate does not vary significantly between the two examination methods (P>0.05). The detection rate of frequent premature beats, atrial tachycardia, and atrial flutter and atrial fibrillation by AECG are significantly higher than those by esophageal cardiac electrophysiological examination (P<0.05). The detection rate of atrioventricular nodal reentrant tachycardia and atrioventricular reentrant tachycardia by esophageal electrophysiological examination are significantly higher than those by AECG (P<0.05). Conclusion Both of AECG and esophageal cardiac electrophysiological examination can be widely used in the population with palpitation. The two testing methods differ in the detection rate of various types of arrhythmia.
		2021 Vol. 30 (1): 28-31 [Abstract] ( 67 ) [HTML 1KB] [ PDF 875KB] ( 891 )

	32	Evaluation value of heart rate variability and arrhythmia on prognosis of patients with acute pulmonary embolism

		Objective To explore the clinical value of heart rate variability (HRV) and the incidence of arrhythmia on the risk stratification and prognostic evaluation of acute pulmonary embolism (APE). Methods The clinical data of 100 APE patients admitted to our hospital were retrospectively analyzed. All of them had been diagnosed by imaging examination. According to the clinical manifestations, simplified pulmonary embolism severity index, right ventricular dysfunction and levels of myocardial injury markers, the enrolled patients were divided into high risk group (33 cases), medium risk group (41 cases), and low risk group (26 cases). Within 24 hours after being diagnosed, patients of each group underwent 24-hour ambulatory electrocardiography examination, with HRV indexes including SDNN, SDANN and ASDNN, the incidence of arrhythmias, and the detection rate of various types of arrhythmias recorded. Meanwhile, the levels of NT-proBNP and D-dimer were tested, and made univariate regression analysis along with HRV indexes and the incidence of arrhythmias, so as to clarify the independent variables affecting the risk stratification of APE. Results The incidence of arrhythmia in highrisk group is significantly higher than that in medium and low risk group (P<0.05) while the incidence of arrhythmia in mediumrisk group is significantly higher than that in lowrisk group (P<0.05). The HRV indexes of SDNN, SDANN and ASDNN in high risk group are significantly lower than those in medium and low risk group with statistically significant differences (P<0.05). The levels of NT-proBNP and D-dimer in high risk group are significantly higher than those in medium and low risk group (P<0.05). The orderly multi-classified Logistic regression analysis shows that ventricular arrhythmia, atrioventricular and bundle branch block, SDNN, and NT-proBNP and D-dimer level are independent risk factors for the risk stratification of APE (P<0.05). Conclusion HRV indexes and the incidence of arrhythmia can be used as important reference indicators for making risk evaluation of APE, and the former can be applied in the prognostic evaluation of APE patients.
		2021 Vol. 30 (1): 32-36 [Abstract] ( 60 ) [HTML 1KB] [ PDF 931KB] ( 705 )

	37	Early diagnostic value of echocardiographic layer specific strain technique on hypertensive heart disease
		HUANG Min, HU Fuchang, HE Lipin, CHEN Yanhua
		Objective To explore the value of echocardiographic layer specific strain technique for early diagnosis of hypertensive heart disease. Methods A total of 137 patients with essential hypertension were selected as case group whose left ventricular ejection fraction (LVEF) was ≥50% while 137 volunteers matched with (age±5) and gender in 1 ∶1 were selected as control group who had undergone physical examination in our hospital during the same period. Routine echocardiography was performed to collect relevant parameters, and the cases were divided into left ventricular hypertrophy (LVH) group and nonLVH group (NLVH group) according to the “Expert consensus on the diagnosis and treatment of hypertension complicated with left ventricular hypertrophy in Asia”. The longitudinal peak strain (LPS) and the time to peak longitudinal strain (TTPLS) in myocardial systolic phase of the subendocardial layer, endocardial layer and epicardium were detected by layered strain technique while the global longitudinal peak strain (GLPS) and the peak strain dispersion (PSD) were calculated. ResultsLVEF does not vary significantly among the three groups (P>0.05). Left atrium diameter (LAD) of the NLVH group is higher than that of the control group; in LVH group, LAD, left ventricular end diastolic diameter (LVEDD), left ventricular endsystolic diameter (LVESD) and interventricular septal thickness (IVST) are all greater than those in the control group (P<0.05); there is no statistically significant difference of LVEDD, LVESD and IVST between the NLVH and control group (P>0.05). In the LVH group, LPS values in myocardial systolic phase of subendocardial and endocardial layer are higher than those in the control group and NLVH group (P<0.05); there is no statistically significant difference of LPS in myocardial systolic phase of subendocardial and endocardial layer between the control group and NLVH group. LPS value in myocardial systolic phase of epicardial layer dose not vary significantly among the three groups (P>0.05). In the LVH group, the TTPLS values in subendocardial, endocardial and epicardial layer are significantly lower than those in the control group and NLVH group (P<0.05); there is no statistically significant difference of TTPLS value in subendocardial and epicardial layer between the control group and the NLVH group (P>0.05); in the NLVH group, TTPLS value in endocardial layer is significantly lower than that in the control group (P<0.05). From the control group to the NLVH and LVH group, the PSD value sequentially increases while GLPS value sequentially decreases (P<0.05). Conclusion The left ventricular lesions of hypertensive patients with preserved LVEF could be evaluated by PSD and GLPS through echocardiographic layerspecific strain technique. It provides a reference for the early diagnosis of hypertensive heart disease.
		2021 Vol. 30 (1): 37-41 [Abstract] ( 62 ) [HTML 1KB] [ PDF 911KB] ( 1026 )

	42	Experience in establishment and quality control management of remote electrophysiological diagnostic center
		MA Caihong, WANG Na
		As an important part of telemedicine, remote ECG monitoring has become one of effective means to solve the problems of insufficient ECG diagnostic capacity and limited standardization level in remote areas and primary health facilities at present. Quality control of remote ECG diagnosis is critical to guarantee the homogenization of medical services. This paper takes the Remote Electrophysiological Diagnostic Center of Xining First Medical Group as an example, and introduces its establishment experience in the normalization of system and standardization of quality control assessment. It also explores the main advantages of the center and problems in the application. The experience is worthy of being adopted in the establishment and operation of remote electrophysiological diagnostic center, especially in the quality control management of telemedicine diagnosis.
		2021 Vol. 30 (1): 42-45 [Abstract] ( 61 ) [HTML 1KB] [ PDF 1678KB] ( 862 )

	46	Application mode of single lead wearable remote ECG monitoring device in patients with symptomatic arrhythmia
		YU Xinyan, WANG Zhixin, LANG Liguo, CUI Yuanyuan, LI Fangjie
		Objective To explore the application effect of different monitoring modes of single lead wearable remote ECG monitoring equipment in patients with symptomatic arrhythmia. Methods A total of 40 patients diagnosed with arrhythmia in Yinchuan primary medical institutions were selected as research subjects. In clinical seizure of symptoms such as dizziness, chest tightness, palpitation and shortness of breath within two weeks, those patients undergoing 24hour ECG test by selfwearing single lead wearable ECG monitoring equipment once were classified into the control group, and those taking 1hour ECGs for five times were considered as the observation group. The data were uploaded to the cloud in real time and diagnosis was made by the Remote ECG Diagnosis Center of Yinchuan First Peoples Hospital. The detection rate of arrhythmia in the observation and control group was statistically analyzed. Results The detection rate of arrhythmia in the observation group is higher than that in the control group(77.5% vs.72.5%), without statistically significant difference(P>0.05) and with medium consistency (Kappa=0.601). The number of wearing times in the observation group is positively correlated with the detection rate of arrhythmia(r＝0.94, P<0.05).Conclusion For patients with symptomatic arrhythmia, the detection rate of arrhythmia does not significantly varied between multiple collections of 1hour ECG and single collection of 24hour ECG by single lead wearable remote ECG monitoring equipment. The more times they wear, the higher the detection rate of arrhythmia.
		2021 Vol. 30 (1): 46-49 [Abstract] ( 68 ) [HTML 1KB] [ PDF 1425KB] ( 810 )

	50	Can the phenomenon of ventricular pre-excitation in ECGs be called preexcitation syndrome?
		WANG Fujun, LUO Dan, ZHANG Zhou
		Domestic dispute remains on whether the phenomenon of ventricular pre-excitation in ECGs can be called pre-excitation syndrome. This paper reviews the cognitive process and discovery of pre-excitation syndrome that is deemed to be a normalized nomenclature with different patterns of manifestation in ECGs and clinical features. Emergence of the phenomenon of ventricular pre-excitation in ECGs combined with a history of tachycardia can be called pre-excitation syndrome; however, ventricular pre-excitation ECG is also suggestive of preexcitation syndrome even though a history of tachycardia is absent. Likewise, it can also be implied by accessory pathway involved tachycardia without ventricular preexcitation ECG. Undoubtly, it should also be diagnosed as preexcitation syndrome for patients without tachycardia, but with ventricular pre-excitation ECG and decline of left ventricular systolic function.
		2021 Vol. 30 (1): 50-52 [Abstract] ( 49 ) [HTML 1KB] [ PDF 894KB] ( 678 )

	53	Common arrhythmias and therapeutic strategies in children
		CHEN Qiushi, WANG Cheng, ZHAO Yingming, CAO Kejiang
		Arrhythmias are common clinical diseases in a pediatric population. In children, the occurrence spectrum of arrhythmias, clinical manifestations,and drug selection, catheter ablation contraindications and indications are different since childrens developmental level of the heart, substrate of arrhythmia and selfexpression capability are different from adults’. In recent years, the field of arrhythmia treatment has developed rapidly; the indications of medication and catheter ablation therapies for the treatment of children’s arrhythmias have also been changed. This paper reviews on the manifestations and therapeutic strategies of common arrhythmias in children, aiming to serve as a reference for the clinical management of children’s arrhythmias.
		2021 Vol. 30 (1): 53-58 [Abstract] ( 53 ) [HTML 1KB] [ PDF 961KB] ( 947 )

	59	New viewpoints on arrhythmogenic right ventricular cardiomyopathy
		YANG Fengjing, LIU Wenling
		With the advances of research on arrhythmogenic right ventricular cardiomyopathy (ARVC), it has no longer only been attributed to a kind of right ventricle involved genetic cardiomyopathy resulted from mutations of desmosome protein at present. ARVC can be caused by multiple nondesmosome gene mutations or nongenetic factors, and the left ventricle can be first involved. Therefore, International Task Force proposed a new clinical classification of the disease in 2019, and made a new evaluation of the 2010 diagnostic criteria. This paper reviews on the research development of clinical classification, pathogenic genes, diagnosis and treatment of ARVC.
		2021 Vol. 30 (1): 59-63 [Abstract] ( 64 ) [HTML 1KB] [ PDF 933KB] ( 911 )

	64	Advances on roles of autophagy in diabetic cardiomyopathy pathogenesis
		ZHU Jinxiu, WU Shenglin,HU Zuoqi, TAN Xuerui
		Diabetic cardiomyopathy (DCM) is an important cause of heart failure and death in diabetic patients. Excessive autophagy leads to myocardial injury, which may potentially contribute to the occurrence and development of DCM. This article reviews the mechanism of autophagy in the pathogenesis of DCM. Besides protection against oxidative damage, the nuclear transcription factor Nrf2 can inhibit excessive autophagy by negative regulation of AMPK. Increasing the activity of Nrf2 can inhibit AMPK-ULK1-Beclin1 pathway, reduce the activity of autophagy, and alleviate DCMcaused myocardial injury. It is expected to provide a new direction for DCM prevention and treatment.
		2021 Vol. 30 (1): 64-67 [Abstract] ( 71 ) [HTML 1KB] [ PDF 891KB] ( 746 )

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		2021 Vol. 30 (1): 68-70 [Abstract] ( 50 ) [HTML 1KB] [ PDF 6176KB] ( 815 )

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		2021 Vol. 30 (1): 71-73 [Abstract] ( 39 ) [HTML 1KB] [ PDF 9380KB] ( 846 )

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		2021 Vol. 30 (1): 74-76 [Abstract] ( 53 ) [HTML 1KB] [ PDF 5917KB] ( 721 )

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