JOURNAL OF PRACTICAL ELECTROCARDIOLOGY

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JOURNAL OF PRACTICAL ELECTROCARDIOLOGY

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JOURNAL OF PRACTICAL ELECTROCARDIOLOGY

	2021 Vol.30 Issue.2 Published 2021-04-28

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		2021 Vol. 30 (2): 74-74 [Abstract] ( 14 ) [HTML 1KB] [ PDF 81383KB] ( 522 )

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		2021 Vol. 30 (2): 75-75 [Abstract] ( 24 ) [HTML 1KB] [ PDF 10442KB] ( 623 )

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		2021 Vol. 30 (2): 76-76 [Abstract] ( 33 ) [HTML 1KB] [ PDF 803KB] ( 610 )

	77	Progress in diagnosis and treatment of cardiac amyloidosis related arrhythmias
		QIU Jia, LI Liwen
		Cardiac amyloidosis (CA) is manifested by restrictive cardiac dysfunction diseases resulted from deposition of extracellular protein fibrils in the myocardium. Various types of atrial arrhythmias and ventricular arrhythmias are common in CA patients. Sufficient evidencebased medical evidences with regard to the management of CA related arrhythmias are scarce at present. Therapeutic decision is mostly made according to clinical experience and expert consensus. Based on the latest references, and related expert consensus and guideline recommendations, this review covers the diagnosis and treatment of CA related arrhythmias.
		2021 Vol. 30 (2): 77-81 [Abstract] ( 68 ) [HTML 1KB] [ PDF 968KB] ( 746 )

	82	Analysis on clinical ECG of patients with cardiac amyloidosis
		ZHANG Yanchun, DONG Jianting, FENG Li, YUAN Yong, SUN Jie, LIU Cui, HU Bing
		Objective To analyze the characteristics of clinical ECGs of patients with cardiac amyloidosis (CA). Methods Retrospective analysis was carried out on the characteristics of clinical ECGs of 45 CA patients definitely diagnosed in our hospital. Results Among the ECG manifestations of 45 cases, tachyarrhythmias include occasional atrial premature beats (19 cases, 42.22%), atrial tachycardia (16 cases, 35.56%), atrial fibrillation (14 cases, 31.11%), occasional premature ventricular contraction (12 cases, 26.67%), frequent premature ventricular contraction (8 cases, 17.78%), nonsustained ventricular tachycardia (6 cases, 13.33%); slow arrhythmias include sinus bradycardia (11 cases, 24.44%), sinus arrest over 2.0 s (3 cases, 6.67%), first-degree atrioventricular block (8 cases, 17.78%), second-degree atrioventricular block (2 cases, 4.44%), ventricular escape rhythm (2 cases, 4.44%), severe ventricular arrest (1 case, 2.22%) with the longest arrest duration of 6.16 s; other ECG manifestations are QRS low voltage, waveform of false infarction, ST-T changes, bundle branch block and so on. Conclusion ECG examination is easy and convenient to be operated with high feasibility. It is helpful in the early diagnosis of CA.
		2021 Vol. 30 (2): 82-85 [Abstract] ( 56 ) [HTML 1KB] [ PDF 909KB] ( 701 )

	86	Analysis of heart rate variability in patients with cardiac amyloidosis
		LI Wenting, DONG Jianting, LIU Cui
		Objective To study the change regulation of heart rate variability (HRV) and its clinical significance in patients with cardiac amyloidosis (CA). Methods Thirty CA inpatients (CA group) and 33 healthy adult volunteers (control group) were selected for comparative analysis of HRV indexes recorded by 24-hour ambulatory electrocardiograph. Results Compared with the control group, the HRV indexes of SDNN, SDNN Index, triangle index, SDANN, rMSSD, pNN50, HF, LF, and LF/HF ratio of the CA group are all reduced. Among them, SDNN, SDNN Index, triangle index, SDANN, LF and LF/HF ratio of the CA group are significantly lower than those of the control group (P＜0.05). Conclusion The decline of HRV indexes in CA patients indicates cardiac autonomic dysfunction. Vagus nerve and sympathetic nerve activities are both weakened, and the latter is dominant.
		2021 Vol. 30 (2): 86-88 [Abstract] ( 65 ) [HTML 1KB] [ PDF 882KB] ( 723 )

	89	Application of artificial intelligence technology in early screening of cardiovascular diseases
		JI Weimin, TANG Shimin, HE Junde, WANG Xuebin, YIN Wei,GE Yishan, LUO Xianyuan
		According to the “Guideline on the assessment and management of cardiovascular risk in China” “Expert consensus on screening and management of cardiovascular risk factors in Chinese physical examination population” and other instructive documents, this paper reviews the status and prospect of the application of artificial intelligence in the early screening of cardiovascular diseases, from aspects of screening and assessment stratification of cardiovascular risk factors, early screening of the populations with low, medium and highrisk of cardiovascular diseases, and the selfexamination of general population.
		2021 Vol. 30 (2): 89-92 [Abstract] ( 79 ) [HTML 1KB] [ PDF 977KB] ( 768 )

	93	Characteristic analysis on scatter plot of atrial autonomic rhythm continuously capturing sinus rhythm
		YANG Wei,JING Yongming,ZHANG Fangfang,LI Shifeng
		Objective To explore the advantages of the joint use of three kinds of ECG scatter plots in rapidly analyzing special arrhythmias, and to accumulate experience of complex arrhythmia analysis. Methods Patients with special arrhythmias featured by atrial autonomic rhythm continuously capturing sinus rhythm in Lorenz scatter plot were selected; their time scatter plot and difference scatter plot were jointly analyzed. Based on reversal technique and mathematical model, the characteristics of cardiac cycle and schematic principle were analyzed, and the nature of arrhythmias was clarified. Results The three kinds of ECG scatter plots have their own characteristics. Time scatter plot shows the stratification law of typical atrial premature beats: the purple bottom layer (NS, SS) is compact and dense while the medium layer (NN) and top layer (SN) is relatively sparse; the medium and top layers disappear in parts of time intervals, only leaving purple bottom layer (SS) extending backward. In the Lorenz scatter plot, typical point set of atrial premature beats, and point set before and after premature beats can be observed. However, the point set of sinus rhythm(NNN) along the 1 s line is sparse or absent while a large number of point sets of atrial rhythm (SSS) are overlapped in NNN beneath the 1 s line. It shows the characteristics of atrial autonomic rhythm continuously capturing sinus rhythm. In the difference scatter plot, a large number of point sets of continuously released atrial rhythm (NSSN, SSSN) are distributed at the positive side of y axis while a large number of point sets of atrial rhythm (SSSS) are overlapped in the point set of sinus rhythm (NNNN). From a macroscopic view of scatter plot, atrial rhythm is dominant since its selfdiscipline reaches or slightly exceeds that of sinus rhythm. In the occurrence of intermittent efferent block, sinus rhythm is re-captured by atrial rhythm only after two beats of capture. This is the reason for the absence of point set NNN over the 1 s line, replaced by lower point set SSS. Since the original rhythm of atrial rhythm is disrupted by the two beats of sinus capture, there is no protective afferent block in atrial rhythm of this example, and it is actually atrial autonomic rhythm with increased self-discipline. Conclusion The joint use of three kinds of ECG scatter plots provides a macroscopic view for identifying the nature of special complex arrhythmias. It shows obvious advantages in the rapid analysis of complex arrhythmias.
		2021 Vol. 30 (2): 93-97 [Abstract] ( 52 ) [HTML 1KB] [ PDF 11352KB] ( 651 )

	98	Dynamic evolution of ECG from de Winter syndrome to acute anterior ST segment elevation myocardial infarction: A retrospective analysis
		SHEN Deng, QIU Huimin, YE Lu, LIU Zongjun
		Objective To investigate the population characteristics and risk factors of de Winter syndrome evolved to acute anterior ST segment elevation myocardial infarction (STEMI). Methods A total of 156 patients diagnosed with acute anterior STEMI (typical anterior STEMI group) and 13 patients with de Winter syndrome evolved to acute anterior STEMI (de Winter evolution group) were enrolled in our study. Retrospective analysis was performed on their clinical data including age, gender, past medical history, echocardiographic results and clinical adverse events. The baseline characteristics between the two groups were compared. ResultsThe median time of ECG evolving from de Winter to ST segment elevation is 29.6 min. Different from typical anterior STEMI group, all of the patients in the de Winter evolution group are young males [(61±26) years old vs. (36±12) years old, P<0.01]; the incidence of hyperlipidemia of the patients in the de Winter evolution group are lower than that of cases in the typical anterior STEMI group (71.8% vs. 23.1%, P<0.01). Coronary angiographic results show that in the de Winter evolution group, the culprit vessels are all anterior descending coronary artery, and the TIMI blood flow is 0-1 (total or near occlusion). Conclusion The ECG manifestation of de Winter syndrome is highrisky, and progressive de Winter syndrome is a subtype of de Winter syndrome which is more common in young males. Percutaneous coronary intervention should be performed as early as possible for these patients.
		2021 Vol. 30 (2): 98-103 [Abstract] ( 52 ) [HTML 1KB] [ PDF 15071KB] ( 608 )

	104	Risk factors of atrial fibrillation in patients with hyperthyroidism
		WANG Liying, WANG Xinkang
		Objective To explore the risk factors of atrial fibrillation (AF) in patients with hyperthyroidism. Methods From 755 patients diagnosed with hyperthyroidism in our hospital, we selected 112 cases with first AF seizure as the research group and another 112 cases without AF as the control group. We analyzed and compared the thyroid function indicators (FT3, FT4, TSH, TPOAB, TGAB and TRAB), cholesterin, triacylglycerol, past medical histories of hypertension, diabetes and smoking, inner diameter of left and right auricle(ventricle), ejection fraction, the maximum P-wave duration (Pmax), and P-wave dispersion (PWD) between the two groups. Multivariate Logistic regression analysis of the above possible risk factors was performed. ResultsThe indexes of FT3 and TSH, history of hypertension, inner diameter of left and right auricle, Pmax, and PWD vary significantly from the research group to the control group (P＜0.05). Regression analysis results show that TSH, history of hypertension, inner diameter of left auricle and PWD are independent risk factors of AF in patients with hyperthyroidism. Conclusion For patients with hyperthyroidism complicating low TSH level, left atrial hypertrophy, increased PWD or history of hypertension, clinicians must keep high alert for the occurrence of AF and make early clinical interventions to reduce longterm complications.
		2021 Vol. 30 (2): 104-107 [Abstract] ( 59 ) [HTML 1KB] [ PDF 937KB] ( 818 )

	108	Clinical value of ECG among infants and children with hyperkalemia
		WEN Jie, ZHENG Fei, WEI Xin,LI Hualian
		Objective To explore the clinical value of electrocardiogram (ECG) in evaluating the influence of serum potassium concentration(SPC) on child patients cardiac conduction system and hemodynamics. MethodsE CG and other clinical data were selected from 48 cases of infants or children with hyperkalemia in our hospital; the relationship among the ECG manifestations, SPC, clinical symptoms and prognosis were observed. The enrolled child patients were divided into 4 groups—mild, moderate, severe and extremely severe group according to SPC; they were classified into group A-E in turn according to the degree of ECG abnormalities related to hyperkalemia from mild to severe. Those patients without hyperkalemia related ECG manifestation were set as control group. Results Positive correlation trend is shown between the abnormality degree of ECG changes and SPC. In the absence of sinoventricular conduction (group A, B and C), common ECG changes related to hyperkalemia are found in those cases with mild and moderate increase of SPC; there is no patient with severe increase of SPC or case of death. In the presence of sinoventricular conduction (group D and E), the patients with severe increase of SPC are the majority; they are mainly complicated by complex arrhythmia ECG changes while all of them are found hemodynamic changes; there are three cases of death among these patients. In the control group, SPC variation is not accompanied by hyperkalemia related ECG changes; no adverse outcome is found. Conclusion ECG changes can reflect the influence of SPC variation on the cardiac conduction system rapidly and accurately. For the patients with hyperkalemia, it is suggested to closely observe ECG changes to prevent hemodynamic abnormalities, and apply calcium channel blockers in time to reverse the influence of SPC changes so as to improve child patients’ prognosis. Clinicians should especially avoid the delay of treatment opportunities for judging the disease’s progress only from the increase of SPC.
		2021 Vol. 30 (2): 108-112 [Abstract] ( 30 ) [HTML 1KB] [ PDF 3788KB] ( 598 )

	113	Relationship between heart rate recovery and gender in normal people after exercise：A singlecenter study
		HU Xiaolei1 LV Hang,YU Xiuming, GONG Liwen, CHEN Xiuling
		Objective To explore the relationship between heart rate recovery (HRR) and gender in normal people after exercise. Methods Through treadmill exercise test, the HRR values of 439 normal people 1 minute, and 2, 3, 4, 5, 6 and 7 minutes after exercise were collected. The subjects were divided into male and female groups. The HRR values of the two groups were calculated from the 5th to the 95th percentile respectively. The correlation between age and HRR in the two groups, and the difference of HRR between genders were analyzed. The tendency chart of HRR in males and females at each time point after exercise was drawn; the HRR values at two adjacent time points were compared separately in the two groups. Results Male’s age is lowly negatively correlated with HRR; the longer the exercise recovery time is, the strong the correlation is. There is no correlation between female’s age and HRR. The difference of HRR between males and females is statistically significant (P<0.05). Female’s HRR reaches steady state 3 minutes after exercise while male’s HRR reaches steady state 5 minutes after exercise. Conclusion The older the male is, the smaller the HRR value is; female’s HRR is not affected by age, but her recovery of heart rate after exercise is faster than the male’s.
		2021 Vol. 30 (2): 113-116 [Abstract] ( 77 ) [HTML 1KB] [ PDF 945KB] ( 819 )

	117	Correlation between P-wave dispersion and heart rate variability in subclinical hypothyroidism patients with paroxysmal atrial fibrillation
		CHEN Xing, XIAO Pingxi
		Objective To explore the correlation between P-wave dispersion (PWD) and heart rate variability (HRV) in subclinical hypothyroidism (SCH) patients with paroxysmal atrial fibrillation (PAF). Methods A total of 71 SCH patients treated by our hospital were enrolled, and they were divided into AF group (37 cases) and control group (34 cases) according to whether they were accompanied with PAF. The maximum P-wave duration (Pmax), the minimum Pwave duration (Pmin) and PWD of 12-lead electrocardiogram (ECG) were measured in the two groups. HRV indexes including SDNN, SDANN, rMSSD, pNN50, LF and HF were compared between the two groups. Results Pmax and PWD of the AF group are significantly higher than those of the control group (P< 0.05). The time domain HRV indexes including SDNN, SDANN, rMSSD and pNN50 of the AF group are significantly lower than those of the control group(P<0.05). The frequency domain HRV indexes including LF and HF of the AF group are both significantly lower than those of the control group (P< 0.05). Pmax and PWD are negatively correlated with HRV indexes(P<0.05). ConclusionP WD significantly increases in SCH patients with PAF, which is closely related to functional dysregulation of cardiac autonomic nerve.
		2021 Vol. 30 (2): 117-120 [Abstract] ( 34 ) [HTML 1KB] [ PDF 921KB] ( 587 )

	121	Diagnostic value of fullinformation precision ECG for stable coronary artery disease
		ZHANG Yanping, YANG Yali, HUANG Weibin, LI Meijuan
		Objective To investigate the diagnostic value of Saah electrocardiogram (Saah ECG) for stable coronary artery disease(SCAD). Methods We selected 75 inpatients with suspected SCAD. Their SaahECG was recorded before coronary angiography(CAG) examination. According to the CAG results, those patients with main branches of coronary artery stenosis≥50% were classified into CAG positive group (n=42) while those with coronary artery stenosis＜50% were classified into CAG negative group (n=33). Ri interval, Rt interval and Ri/Rt of SaahECG were calculated respectively. ResultsIn the diagnosis of SCAD, the sensitivity and specificity of Saah ECG is separately 80.9% and 81.8%, the positive and negative predictive value is separately 85.0% and 77.1%, and the positive and negative likelihood ratio is 4.445 and 0.233, respectively. The Ri/Rt ratio of CAG positive group is significantly higher than that of CAG negative group ［(1.216±0.329) vs. (0.820±0.309),P＜0.05］. Conclusion SaahECG has relatively high clinical application value for the diagnosis of SCAD. It is expected to become an important examination method for the diagnosis of coronary heart disease.
		2021 Vol. 30 (2): 121-124 [Abstract] ( 59 ) [HTML 1KB] [ PDF 2541KB] ( 884 )

	125	Clinical electrocardiology analysis of patients with idiopathic premature ventricular contraction or ventricular tachycardia originating from the aortic root
		MA Zhenhua,DU Weiguo
		Objective To explore the surface electrocardiogram (ECG) and intracardiac electrophysiological characteristics of patients with idiopathic premature ventricular contraction (IPVC) or ventricular tachycardia (VT) originating from the aortic root. Methods Retrospective analysis was performed on the clinical data of 32 patients diagnosed with IPVC or VT originating from the aortic root (research group) in our hospital. Their surface ECG and intracardiac electrophysiological characteristics were analyzed. Thirty patients with right ventricular outflow tract PVC or VT who had been treated in our hospital during the same period were selected as the control group. The ECGrelated parameters were compared between the two groups, and their diagnostic efficacy on PVC or VT originating from the aortic root was analyzed by using ROC curve. ResultsPatients in the research group are mainly manifested by left bundle branch block plus downward electrical axis with prethoracic lead shifting before lead V3, primarily rsr~ and rS waveform in lead Ⅰ, and mainly QS waveform in lead aVL. The R wave duration and R wave amplitude index of patients in the research group are both higher than those in the control group (P>0.05). ROC curve analysis shows that ECGrelated parameters have certain diagnostic efficacy on the patients with PVC or VT originating from the aortic root (P<0.05). Conclusion Compared with ECG results of IPVC or VT originating from common sites, those originating from the aortic root are featured by unique ECG manifestations. R wave duration and R wave amplitude index have certain clinical values on distinguishing IPVC or VT originating from the aortic root from right ventricular outflow tract IPVC or VT.
		2021 Vol. 30 (2): 125-128 [Abstract] ( 35 ) [HTML 1KB] [ PDF 3175KB] ( 802 )

	129	Advance in application of intracardiac echocardiography for interventional diagnosis and treatment of atrial fibrillation
		DU Xianfeng, ZHUO Weidong, CHU Huimin
		Catheter ablation and percutaneous left atrial appendage closure, as the representative for interventional procedures, have been recognized as efficacious treatments for symptom relief and cardiogenic stroke prevention in patients with atrial fibrillation (AF). Progress and evolution of imaging techniques has been significantly boosting the everchanging improvement of AF interventional techniques. This paper reviews the clinical updates of the application of intracardiac echocardiography in the AF interventional therapies.
		2021 Vol. 30 (2): 129-134 [Abstract] ( 43 ) [HTML 1KB] [ PDF 1081KB] ( 990 )

	135	Clinical application of excimer laser coronary atherectomy in complex coronary artery lesion
		DAI Xinyi, DING Shu
		In the last decade, with the improvement of equipments and techniques (low wavelength, low pulse energy, Heparin saline infusion technique and design of catheter in multiple sizes), excimer laser coronary atherectomy (ELCA) is increasingly used in the adjuvant treatment of complex coronary artery disease. ELCA dissolves arterial plaques by photochemical, photothermal and photomechanical processes to obtain larger arterial lumen area. Optical coherence tomography imaging demonstrates that the most important mechanism of ELCA is tissue ablation, facilitation of pressure delivery to the vessel and tissue compression. In addition, laser pulses could weaken the connection between tissues, and thus promote tissues to stretch. At present, ELCA is mainly applied in patients with chronic total occlusion, severe calcification lesions, severe instent restenosis, no access of balloon or stent(balloon) incomplete intumescence, and complex coronary artery lesions including saphenous vein graft disease and acute thrombotic disease. It not only improves the success rate of percutaneous coronary intervention, but also reduces the complications, which shows significant advantages in treating complex and refractory coronary artery diseases.
		2021 Vol. 30 (2): 135-139 [Abstract] ( 48 ) [HTML 1KB] [ PDF 1000KB] ( 1156 )

	140	Advances of research in relationship between Helicobacter pylori and atrial fibrillation
		FENG Weiting,XIAO Yichao
		As a gramnegative bacterium that exists in the human gastric mucosa, Helicobacter pylori has a non-negligible harm to the human body. Atrial fibrillation, as the most common persistent arrhythmia, has a high morbidity, mortality and disability. Several recent studies have shown that Helicobacter pylori is closely related to atrial fibrillation. This paper reviews on the possible pathogenesis of atrial fibrillation caused by Helicobacter pylori, epidemiology of atrial fibrillation, and the predictive value of Helicobacter pylori related indexes on the treatment and prognosis of atrial fibrillation.
		2021 Vol. 30 (2): 140-143 [Abstract] ( 43 ) [HTML 1KB] [ PDF 935KB] ( 859 )

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		2021 Vol. 30 (2): 144-148 [Abstract] ( 43 ) [HTML 1KB] [ PDF 14436KB] ( 641 )

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		2021 Vol. 30 (2): 149-152 [Abstract] ( 39 ) [HTML 1KB] [ PDF 24473KB] ( 583 )

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		2021 Vol. 30 (2): 153-153 [Abstract] ( 36 ) [HTML 1KB] [ PDF 851KB] ( 604 )

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		2021 Vol. 30 (2): 154-154 [Abstract] ( 24 ) [HTML 1KB] [ PDF 803KB] ( 618 )

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