JOURNAL OF PRACTICAL ELECTROCARDIOLOGY

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JOURNAL OF PRACTICAL ELECTROCARDIOLOGY

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JOURNAL OF PRACTICAL ELECTROCARDIOLOGY

	2022 Vol.31 Issue.4 Published 2022-08-18

	226


		2022 Vol. 31 (4): 226-226 [Abstract] ( 15 ) [HTML 1KB] [ PDF 62616KB] ( 642 )

	227


		2022 Vol. 31 (4): 227-227 [Abstract] ( 15 ) [HTML 1KB] [ PDF 10442KB] ( 559 )

	228


		2022 Vol. 31 (4): 228-228 [Abstract] ( 17 ) [HTML 1KB] [ PDF 332KB] ( 487 )

	229	Interpretation of “2021 ACC/AHA/SCAI Guideline for coronary artery revascularization”
		REN Li, ZHANG Dingguo
		In December 2021, ACC/AHA/SCAI jointly released the new version of Guideline for coronary artery revascularization. Combined with the evidencebased medicine evidences of coronary revascularization, and clinical practice of diagnosis and treatment in recent years, the guideline updates the coronary revascularization strategies for patients with stable ischemic heart disease, nonSTsegment elevation acute coronary syndrome and STsegment elevation myocardial infarction. It covers the comprehensive management strategies such as medicine, intervention and surgical therapy for coronary artery disease. The guideline illustrates from the aspects of lesion assessment, scheme selection, treatment and recovery. This paper interprets the guideline’s highlights so as to provide references for clinical practice.
		2022 Vol. 31 (4): 229-237 [Abstract] ( 46 ) [HTML 1KB] [ PDF 7334KB] ( 897 )

	238	Research advances in anthracyclinesrelated arrhythmias
		WANG Yueying, LIU Tong
		Anthracyclines are widely used in various malignancies including breast cancer, sarcoma, leukemia and lymphoma. However, anthracyclines have attracted much attention because of their cardiotoxicity at present. Even at therapeutic doses, anthracyclines may also induce various types of arrhythmias including atrial fibrillation, supraventricular tachycardia, premature ventricular beats and ventricular tachycardia. Anthracyclines are independent risk factors for arrhythmias, which may be a marker of poor cardiovascular prognosis and clinical outcomes. Although the optimal treatment strategies for anthracyclinesrelated arrhythmias have not been found, it is essential for patients with a history of anthracyclines use to take standard and longterm ECG monitoring. Centering on anthracyclinesrelated arrhythmias, this paper reviews their types, epidemiology, mechanism, and treatment and management.
		2022 Vol. 31 (4): 238-242 [Abstract] ( 36 ) [HTML 1KB] [ PDF 893KB] ( 540 )

	243	Advance in research on diagnosis and treatment of doxorubicininduced cardiotoxicity by exosomal noncoding RNA
		TIAN Chao, WU Qinchao, CHU Xianming
		Doxorubicin (DOX) is widely applied in hematologic and solid tumor chemotherapy, which greatly prolongates the survival time of cancer patients. However, at the same time, the accumulation of DOX in noncancer tissues also causes “offtarget effect”, that is chemotherapyrelated toxicity, among which doxorubicininduced cardiotoxicity (DIC) is the most significant and fatal. However, there is no effective means to diagnose and treat DIC at present. In recent years, studies on exosomes have been in the ascendant. The advantages such as heterogeneity, stability and nonimmunogenicity make exosomes ideal diagnostic markers and therapeutic vectors for many diseases. This article mainly aims to review the related studies on the diagnosis and treatment of DIC by non-coding RNA in exosomes.
		2022 Vol. 31 (4): 243-248 [Abstract] ( 29 ) [HTML 1KB] [ PDF 885KB] ( 577 )

	249	Tumor-associated sinus tachycardia
		CHEN Yongzhen, YIN Xi, LIANG Xufei, ZHU Xianxiao, GENG Xuhong, GONG Xiaohong
		Arrhythmia is one of the manifestation types of cardiotoxicity associated with antitumor therapies. In the presence of arrhythmia among patients with tumor, it is inevitable for the clinical treatment strategy of tumor and the outcome to be affected. Antitumorassociated arrhythmias has aroused more and more attention in clinicians. However, as one of the most commonlyseen arrhythmias in patients with tumor, sinus tachycardia is easily to be ignored in clinical practice. This paper reviews the mechanisms, diagnosis, evaluation and treatment of tumorassociated sinus tachycardia.
		2022 Vol. 31 (4): 249-252 [Abstract] ( 40 ) [HTML 1KB] [ PDF 830KB] ( 766 )

	253	Clinical ECG analysis of patients with breast cancer after radiotherapy
		FU Zhengyan, YIN Xi, GENG Xuhong, PAN Shuo, ZHOU Kai, ZHAO Peng
		ObjectiveTo analyze the ECG changes and their clinical significance in patients with breast cancer after radiotherapy. MethodsRetrospective analysis was performed on 103 patients with breast cancer. The ECG indexes of heart rate, PR interval, QRS duration, QT interval, QTc, Sokolow-Lyon index(SLI), ST segment and T wave before radiotherapy (group A), within 3 months after radiotherapy (group B) and more than 3 months after radiotherapy (group C) were analyzed. ResultsAfter radiotherapy, PR interval is gradually extended and there is statistically significant difference between group A and group C (P<0.01); QRS duration is gradually prolonged, and QRS duration of group C varies significantly from either group A or group B (P<0.01); QTc is gradually reduced, however, QTc of group C does not vary significantly from either group A or group B. SLI in group B is lower than that in group A with statistically significant difference (P<0.01). After radiotherapy, the patients with significantly low, flat and inverted T wave compared with that before radiotherapy account for as high as 330%.The difference of the number of patients with T wave abnormalities before and after radiotherapy is statistically significant (P<0.05). ConclusionChanges of ECG indexes before and after radiotherapy may indicate changes of myocardial conduction and depolarization; abnormal T wave may indicate problems such as abnormal myocardial blood supply in an early stage. These changes are mostly not accompanied with clinical manifestations, but may indicate radiotherapy induced myocardial damage among breast cancer patients in an early stage. Regular ECG monitoring might aid in detecting early cardiotoxicity during followup after radiotherapy.
		2022 Vol. 31 (4): 253-255 [Abstract] ( 32 ) [HTML 1KB] [ PDF 850KB] ( 665 )

	256	Study on atrial fibrillation prediction algorithm combining convolutional neural network and bi-directional long short-term memory network
		WANG Lianghong, LI Xin, CHEN Junying, YANG Tao, WANG Xinkang, GAO Jie
		The onset of atrial fibrillation is sudden and often accompanied with serious complications (such as stroke and myocardial infarction) which greatly threats health. With the development of deep learning technology, deep neural network has been widely used in atrial fibrillation classification algorithm due to its advantages including automatic feature extraction. This paper proposes a deep learning framework based on convolutional neural network (CNN) and bi-directional long shortterm memory (Bi-LSTM) network. It could predict atrial fibrillation according to ECG. By using CNN, we extracted the morphological characteristics of ECG signals and made sequence reconstruction. The reconstructed sequence was input into Bi-LSTM network, and the rhythm changes of positive and negative timing were analyzed. It could effectively predict the data within 30 minutes before the occurrence of atrial fibrillation, normal sinus rhythm data and the data at the onset of atrial fibrillation. The proposed algorithm was trained and validated with the data of longterm atrial fibrillation database, MIT-BIH atrial fibrillation database and MIT-BIH normal sinus rhythm database; the accuracy reached 93.3%.
		2022 Vol. 31 (4): 256-261 [Abstract] ( 44 ) [HTML 1KB] [ PDF 2389KB] ( 721 )

	262	Progression of artificial intelligence applied in diagnosis and treatment of atrial fibrillation
		HE Bin, CHU Huimin
		Atrial fibrillation (AF) is the most common arrhythmia in clinical practice. The missed diagnosis rate of AF is high in screening by traditional means, therefore early diagnosis is a great challenge. Artificial intelligence (AI) has broken through the limitations of traditional methods and has shown its unique advantages and broad prospect of application in the screening, diagnosis and treatment of AF. This article reviews the progress of AI applied in the diagnosis and treatment of AF.
		2022 Vol. 31 (4): 262-266 [Abstract] ( 35 ) [HTML 1KB] [ PDF 1583KB] ( 607 )

	267	Relationship between spontaneous reperfusion of infarct-related arteries and T-wave inversion of corresponding leads in patients with ST-segment elevation myocardial infarction
		GAO Liwei, ZHAO Jianfeng, PAN Shuanghua, HAO Yingcai, ZHU Hongtao
		Objective To explore the relationship between spontaneous reperfusion (SR) of infarct-related arteries and T-wave inversion in early ECGs of patients with acute STsegment elevation myocardial infarction (STEMI). Methods A total of 246 acute STEMI inpatients were retrospectively analyzed. The ECG within the first 6 hours of onset (the first ECG recorded by the pre-hospital emergency system or the emergency room) was taken as a criterion of determining the morphology of T-wave in an early phase. All the patients received emergency percutaneous coronary intervention. The patients’ clinical data, ECGs and angiography data were recorded in detail. According to the presence or absence of inverted T-wave in the corresponding leads of infarctrelated vessels, the enrolled subjects were divided into T-wave inversion group (33 cases) and T-wave upright group (213 cases). The incidence of SR was compared between the two groups according to the results of coronary angiography. ResultsIn the 246 patients, SR is found in infarctrelated vessels of 92 patients (37.4%); occlusion occurs in the anterior descending arteries of 120 patients (48.8%), the circumflex arteries of 28 patients (11.4%), and the right coronary arteries of 98 patients (39.8%). Among the patients with occluded anterior descending arteries, T-wave inversion is found in 23 patients (19.2%) while only 2 patients (7.1%) with circumflex artery occlusion and 8 patients (8.2%) with right coronary artery occlusion are recorded T-wave inversion in ECGs. In the STEMI patients with anterior descending artery occlusion and inverted T-wave, SR is confirmed in 19 patients (82.6%, P＜0.01) by coronary angiography; only one case (50.0%, P=0.124) of SR is found in patients with circumflex artery occlusion and inverted T-wave; 3 cases (37.5%,P=0.035) of SR are found in patients with right coronary artery occlusion and inverted T-wave. Conclusion In the ECGs of STEMI patients with anterior descending artery occlusion, early T-wave inversion in the leads with ST-segment elevation may be a predictor for SR in infarct-related arteries.
		2022 Vol. 31 (4): 267-271 [Abstract] ( 36 ) [HTML 1KB] [ PDF 883KB] ( 504 )

	272	Clinical significance of ST-segment and QRS duration in leads V4 and Ⅲ in identifying acute inferior myocardial infarction with left anterior descending artery lesion
		ZHENG Xiaobin, ZHANG Zhaofu
		Objective To study the clinical value of ST-segment changes and QRS duration in leads V₄and Ⅲ in identifying different involvements of the left anterior descending (LAD) artery among patients with acute inferior ST-segment elevation myocardial infarction (STEMI). Methods Retrospective analysis was performed on 189 patients with inferior STEMI who had undergone coronary angiography. Among these patients, 64 were divided into LAD occlusion group (LAD obstruction≥99%, n=17), LAD stenosis group (50%＜LAD obstruction＜99%, n=21) and normal LAD group (without LAD obstruction, n=26) according to different degrees of LAD obstruction in a single culprit vessel (the right coronary artery or left circumflex artery). The clinical data of the three groups were compared; the receiver operating characteristic (ROC) curve was utilized to determine the related cut-off values of ST-segment deviation and QRS duration in leads V4 and Ⅲ. ResultsThe proportion of patients with hypertension or cerebral infarction in the normal LAD group is lower than that in the LAD occlusion group and the LAD stenosis group; the proportion of patients with diabetes or cardiac function of Killip Ⅲ-Ⅳ in the LAD occlusion group is higher than that in the normal LAD group (P＜0.05). The left ventricular ejection fraction in the LAD occlusion group is significantly lower than that in the other two groups(P＜0.01), and the serum NT-proBNP level of the normal LAD group is the lowest (P＜0.01).In terms of electrocardiogram, the deviation of ST-segment depression in lead V4 (STV4↓), the difference between ST-segment depression in lead V4 and STsegment elevation in lead Ⅲ (STV4↓-STⅢ↑), and QRS duration in lead V4 (QRSV4) of patients in the LAD occlusion and LAD stenosis groups are higher than those of patients in the normal LAD group (P＜0.05). QRS duration of lead Ⅲ in the LAD occlusion group is widened as compared to the normal LAD group (P＜0.05). ROC curve analysis indicates that STV4↓-STⅢ↑＞-1.46 mm and QRSV4＞97.38 ms are of high predictive value for patients with inferior myocardial infarction complicating LAD involvement (including LAD occlusion or stenosis). The sensitivity of these two indexes are separately 83.3% and 68.4% while the specificity are 57.1% and 80.8%, respectively. A combination of the two are improved in diagnostic performance with a sensitivity of 76.3% and a specificity of 84.6%. Conclusion Inferior STEMI patients with LAD lesion have many comorbidities, especially in the presence of LAD occlusion, their cardiac function would be worse. The indexes of STV4↓-STⅢ↑ and QRSV4 could provide clues for diagnosing complicated LAD lesions in patients with inferior STEMI.
		2022 Vol. 31 (4): 272-279 [Abstract] ( 29 ) [HTML 1KB] [ PDF 4644KB] ( 636 )

	280	Diagnostic value of transesophageal electrophysiologic study in children and adolescents with paroxysmal supraventricular tachycardia
		YANG Yanqiu,WANG Xinkang
		Objective To explore the diagnostic value of transesophageal electrophysiologic study (TEEPS) in children and adolescents with paroxysmal supraventricular tachycardia (PSVT). Methods We retrospectively analyzed the ECG and electrophysiological data of 156 children and adolescents with palpitation who had undergone TEEPS due to suspected PSVT. The detection rate of PSVT separately by using TEEPS and surface ECG was compared; the sensitivity, specificity and accuracy rate of TEEPS in contrast to intracardiac electrophysiologic study (IEPS) were statistically analyzed. ResultsPSVT is detected in 90 cases by TEEPS. The detection rate of PSVT by TEEPS is significantly higher than that by surface ECG (57.69% vs. 19.87%, χ²=55.15, P＜0.05). With IEPS as the gold standard, the accuracy rate of TEEPS in diagnosing PSVT is 95.38% (62/65). The sensitivity and specificity of TEEPS in diagnosing atrioventricular nodal reentrant tachycardia is 92.86% and 100.00%, respectively; its sensitivity and specificity in diagnosing atrioventricular reentrant tachycardia is separately 97.14% and 93.33%; its sensitivity and specificity in diagnosing intra-atrial reentrant tachycardia both reach 100.00%. Conclusion TEEPS has a certain diagnostic value for screening PSVT and judging its mechanism among children and adolescents.
		2022 Vol. 31 (4): 280-283 [Abstract] ( 35 ) [HTML 1KB] [ PDF 830KB] ( 581 )

	281	Silent cerebral embolism: A non-negligible issue in catheter ablation for atrial fibrillation
		ZHAO Xiaoxi, WANG Ruxing
		Catheter ablation has become the main treatment for atrial fibrillation. However complications such as stroke and embolism may be resulted from catheter ablation, especially silent cerebral embolism (SCE), which can affect nerve function and lead to cognitive dysfunction. Therefore, it is of great clinical significance to prevent and reduce SCE during perioperative period of catheter ablation. This paper systematically reviews the definition, incidence, sites, clinical manifestations, mechanism and risk factors of SCE, and the influence of different ablation methods on SCE, in order to improve clinicians’ understandings of SCE, and prevent and reduce its incidence after catheter ablation for atrial fibrillation.
		2022 Vol. 31 (4): 281-287 [Abstract] ( 28 ) [HTML 1KB] [ PDF 879KB] ( 552 )

	288	Potential mechanisms and clinical research progress of sodium-glucose cotransporter 2 inhibitor in treating heart failure
		LI Jinlong, ZHANG Xianlin
		Sodium-glucose cotransporter 2 (SGLT-2) inhibitor is a kind of novel hypoglycemic drug. It inhibits the reabsorption of glucose from the proximal renal tubules, leading to increased urine sugar and decreased plasma glucose level. Several cardiovascular outcome trials have proved that SGLT-2 inhibitor has significant cardiovascular benefits for both diabetic and nondiabetic patients, especially it can significantly reduce the risk of cardiovascular death or hospitalization due to heart failure (HF) in HF patients. However, its mechanism has not been completely clear. It may be associated with its improvement of heart’s workload, myocardial energy metabolism, ventricular remodeling and myocardial fibrosis, and its effects of protecting the kidney and maintaining heart ion homeostasis. This article reviews the potential mechanism and clinical research progress of SGLT-2 inhibitors in the treatment of HF.
		2022 Vol. 31 (4): 288-293 [Abstract] ( 35 ) [HTML 1KB] [ PDF 888KB] ( 623 )

	294	Role of treadmill exercise test in early diagnosis of arrhythmogenic right ventricular cardiomyopathy
		MA Zhiling, SHAO Hong

		2022 Vol. 31 (4): 294-300 [Abstract] ( 24 ) [HTML 1KB] [ PDF 38436KB] ( 545 )

	301	Predictive value of Aslanger pattern for acute inferior myocardial infarction
		CHE Shuyu, FAN Liangliang, PENG Kaiyue, WU Shaoping, ZHANG Xuejuan
		Objective To explore the clinical value of Aslanger pattern of body surface ECG in predicting acute inferior myocardial infarction (AIMI). Methods We collected 150 ECGs of patients with AIMI which had been firstly recorded before coronary artery opening. These patients were divided into Aslanger pattern group (9 cases) and non-Aslanger pattern group (141 cases). We compared and analyzed coronary angiography results, left ventricular ejection fraction, blood pressure and heart rate, Killip calssification, cTnI, CK-MB and NT-proBNP levels, etc. between the two groups. ResultsIn the Aslanger pattern group, cTnI and NT-proBNP levels, and the proportion of patients at Ⅲ-Ⅳ level of Killip classification are all significantly higher than those in the non-Aslanger pattern group (P＜0.05). Emergency coronary angiography reveals in the Aslanger pattern group, the proportion of patients with coronary lesions in two and three branches are both significantly higher than those in the nonAslanger pattern group (lesions in two branches: 55.56% vs. 17.02%; lesions in three branches: 33.33% vs. 2.83%,P＜0.05). Conclusion The concomitant Aslanger pattern in AIMI patients indicates more severe condition, worse cardiac function, and more likely to be found no less than two branches of coronary artery lesions.
		2022 Vol. 31 (4): 301-304 [Abstract] ( 40 ) [HTML 1KB] [ PDF 821KB] ( 744 )

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