JOURNAL OF PRACTICAL ELECTROCARDIOLOGY

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JOURNAL OF PRACTICAL ELECTROCARDIOLOGY

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JOURNAL OF PRACTICAL ELECTROCARDIOLOGY

	2023 Vol.32 Issue.1 Published 2023-02-13

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		2023 Vol. 32 (1): 0-1 [Abstract] ( 21 ) [HTML 1KB] [ PDF 10443KB] ( 997 )

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		2023 Vol. 32 (1): 0-1 [Abstract] ( 26 ) [HTML 1KB] [ PDF 342KB] ( 477 )

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		2023 Vol. 32 (1): 0-1 [Abstract] ( 23 ) [HTML 1KB] [ PDF 75774KB] ( 619 )

	1	Research of artificial intelligence algorithm for identifying atrial fibrillation from paper-based ECG
		ZHANG Deyun, WEI Guodong, GENG Shijia, WANG Kai, XU Weilun, LIU Xingpeng, HONG Shenda
		Objective To discuss the feasibility of directly processing paper-based ECG by using deep learning method, and to propose a method for identifying atrial fibrillation (AF) from paper-based ECG rapidly and accurately. Methods The 12-lead ECG signals of 1 040 AF and 1 344 non-AF patients were selected from CPSC 2018 Challenge data, and were plotted as ECGs. These ECGs were printed out on papers, and rescanned into images. The paper-based ECGs with white background were obtained by a series of preprocessing. These paper-based ECGs were used to construct AF recognition dataset; the artificial intelligence algorithm (AIA) was trained, validated and tested using the real labels provided by the Challenge as the gold standard. Results The sensitivity, specificity and F1 score of the AIA based on paperbased ECGs are 0.957, 0.978 and 0.969, respectively, and the area under receiver operating characteristic curve is 0.994. The Grad-CAM based feature visualization results show that in paperbased ECGs, the position of P wave and F wave at the onset of AF provide main references for the algorithm to identify AF, which is consistent with the ECG diagnostic criteria of AF in clinical practice. Conclusion The AF recognition algorithm based on paper-based ECGs shows good performance. The visualization results verify the high efficiency and feasibility of directly analyzing paper-based ECGs by using AIA, which could provide guidance for clinical practice.
		2023 Vol. 32 (1): 1-7 [Abstract] ( 109 ) [HTML 1KB] [ PDF 6054KB] ( 1549 )

	8	Artificial intelligence models for predicting severe coronary stenosis from apparently normal ECGs
		薛政凯，耿世佳，郭少华，穆冠宇，徐伟伦，洪申达，陈康寅
		Objective To investigate the performance of different artificial intelligence (AI) models in predicting severe stenosis (≥90%) of major coronary arteries or their main branches in patients with apparently normal ECGs. Methods The preoperative ECGs of patients undergoing selective coronary angiography were collected. From these ECGs we screened out 392 apparently normal ECGs, matched them with coronary angiography results, and then constructed a dataset. The enrolled patients were grouped by the degree of stenosis in major coronary arteries or their main branches. There were 138 patients with severe stenosis (the degree of stenosis≥90%, case group) while there were 254 cases with mild or without stenosis (the degree of stenosis＜50%, control group). We then constructed three deep neural networksbased models: Model 1, Model 2 and Model 3, based on training from scratch using ECG, training from scratch using ECG and clinical information, and transfer learning from a pre-trained ECG classification model, respectively. Results Model 1 eventually achieves an AUC value of 0.65, a sensitivity of 62.5%, a specificity of 66.7%, and F1 score of 0.483. The above performance parameters of Model 2 are separately 0.66, 63.0%, 69.2% and 0.563. The above performance parameters of Model 3 are separately 0.63, 55.6%, 53.8%, and 0.438. Conclusion Model 2 outperforms Model 1 while Model 3 performs slightly worse than Model 1. AI models have potential value in predicting severe coronary stenosis using apparently normal ECGs.
		2023 Vol. 32 (1): 8-14 [Abstract] ( 58 ) [HTML 1KB] [ PDF 6386KB] ( 714 )

	15	Progress of artificial intelligence-enabled ECG analysis technology applied in clinical diagnosis and treatment
		GENG Shijia, ZHOU Yang, XU Weilun, LIU Xingpeng, HONG Shenda
		In an order of the abstract structure of the human body from inside to outside, this paper lists the stateoftheart research advances of artificial intelligence (AI) especially deep neural network in ECG analysis from aspects of electrical conduction system and the structure of the heart (including heart valves, myocardium, coronary arteries, etc.), other systems out of the heart, ect. This paper introduces the application of AIenabled ECG analysis technology in identifying arhythmias, electrolyte disturbances, valvular heart disease, coronary heart disease, and diseases of the circulation system and digestive system. This paper also covers its innovative application in the field of personal identification, and how to use AI technologies such as transfer learning in practical research. This paper is aimed to promote more crossfield cooperations, explore deep values of ECG, and help to realize the screening, diagnosis and treatment of multisystem diseases.
		2023 Vol. 32 (1): 15-21 [Abstract] ( 59 ) [HTML 1KB] [ PDF 1811KB] ( 777 )

	22	Efficiency of artificial intelligence-enabled handheld single-lead device for identifying recurrent atrial fibrillation after radiofrequency ablation
		CHEN Laite, JIANG Chenyang
		Objective To explore the feasibility of handheld devices for screening recurrent atrial fibrillation, and to assess the efficiency of the configurated artificial intelligence algorithm (AIA) for identifying the recurrence of atrial fibrillation. Methods We selected 67 patients diagnosed with paroxysmal atrial fibrillation and treated by radiofrequency ablation. During one-year follow-up after the operation, the ECG information of patients was collected by handheld single-lead device, and uploaded to the cloud at the onset of dizziness, chest tightness, palpitations, shortness of breath and other symptoms. AIA was utilized to analyze and process the collected ECG signals, and identify the event of atrial fibrillation recurrence. Taking the diagnosis of two ECG doctors as the golden criterion, we calculated the sensitivity, specificity, accuracy rate, positive prediction value and F1 score to assess the efficiency of AIA. Results In the 67 patients with paroxysmal atrial fibrillation, AIA screens out 30 cases with recurrent atrial fibrillation while 25 cases are diagnosed with atrial fibrillation recurrence by ECG doctors. The sensitivity, specificity, accuracy rate, positive prediction value and F1 score of AIA in identifying recurrent atrial fibrillation are separately 83.33%, 100.00%, 88.10%, 92.54% and 0.91. There is a strong consistency between AIA and manual check by ECG doctors in diagnosing recurrent atrial fibrillation (Kappa coefficient=0.85). Conclusion AIA-based handheld singlelead device could be used to identify recurrent atrial fibrillation during the follow up after ablation.
		2023 Vol. 32 (1): 22-25 [Abstract] ( 54 ) [HTML 1KB] [ PDF 870KB] ( 652 )

	26	Application of artificial intelligence-enabled ECG diagnostic models in identifying valvular heart diseases
		XIE Bingxin, LIU Tong
		Valvular heart disease (VHD) is a common organic heart disease, and its incidence gradually increases with age. With the crossintegration of artificial intelligence and medical field, artificial intelligence algorithm models have become effective tools for identifying a variety of heart diseases. Artificial intelligenceenabled ECG (AIECG) diagnostic models can identify VHD patients by analyzing their ECG features, which may become an auxiliary tool for the identification of VHD in clinical practice. This paper summarizes the research progress of AIECG diagnostic models in the identification of VHD.
		2023 Vol. 32 (1): 26-29 [Abstract] ( 58 ) [HTML 1KB] [ PDF 856KB] ( 635 )

	30	Clinical value of “ventricle-atrium fusion during atrial S1S1 stimulating” in patients with atrioventricular nodal reentrant tachycardia
		FANG Yuqiang, WEN Chunlan, YANG Lili, YANG Li, ZOU Xue, LIU Yukai
		Objective To explore the clinical significance of “ventricle-atrium(VA) fusion during atrial S1S1 stimulating” in patients with atrioventricular nodal reentrant tachycardia(AVNRT). Methods The electrophysiological data of 2 057 patients were analyzed, among whom 896 patients were diagnosed with ANVRT (including 874 cases with a definite history of tachycardia), and performed improvement of slow path. We analyzed the electrophysiological characteristics of all the patients, especially the clinical features of “S2R jump during atrial S1S2 stimulating” and “VA fusion during atrial S1S1 stimulating”, and their values for predicting the onset and postoperative recurrence of tachycardia. Results The detection rate of “VA fusion during atrial S1S1 stimulating” and “S2R jump during atrial S1S2 stimulating” are 92.9% and 79.8%, respectively (separately 95.3% and 79.3% in those with definite tachycardia); the former is significantly higher than the latter (P＜0.05). In the diagnosis of AVNRT, the positive and negative predictive value are separately 96.9% and 84.5%, the specificity and sensitivity are separately 97.8% and 79.3%, and the positive and negative likelihood ratio are separately 36.400 and 0.211. The above indexes of “VA fusion during atrial S1S1 stimulating” are 100.0%, 96.0%, 100.0%, 95.3%, 941.600, 0.047, respectively. After the ablation for AVNRT, the phenomenon of “S2R jump during atrial S1S2 stimulating” still exists in 10.9%(95/874) of patients, significantly higher than the proportion of “VA fusion during atrial S1S1 stimulating” (1.3%, 11/874, P=0.017). “VA fusion during atrial S1S1 stimulating” is found in all the 9 recurrent patients, among whom only 6 (66.7%) patients are detected “S2R jump during atrial S1S2 stimulating”. Conclusion “VA fusion during atrial S1S1 stimulating” is superior to “S2R jump during atrial S1S2 stimulating” in predicting the onset and postoperative recurrence of tachycardia in patients with AVNRT, which makes the former more valuable in practice as an electrophysiological characteristic.
		2023 Vol. 32 (1): 30-35 [Abstract] ( 43 ) [HTML 1KB] [ PDF 9993KB] ( 683 )

	36	Changes and short-term prognostic prediction value of short-time heart rate variability in patients with acute coronary syndrome after percutaneous coronary intervention
		ZANG Aoqi, WANG Lichao, XUAN Ling, ZHANG Heng
		Objective To investigate the changes of short-time heart rate variability (HRV) in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI), and to discuss the value of HRV indexes in predicting their short-term prognosis. Methods We selected 76 patients who had undergone PCI therapy. They were grouped by the presence or absence of major adverse cardiac events (MACE) within 6 months after PCI. Those patients without MACE were classified into the control group (55 cases) while those with MACE were set as the research group (21 cases). HRV linear indexes of SDNN, rMSSD, LF and HF, and HRV nonlinear indexes of approximate entropy (ApEn), sample entropy (SampEn) and Poincaré scatterplot indexes of SD1 and SD2 were compared between the two groups after PCI. Changes of HRV indexes before and after PCI were compared. Coronary artery Gensini scoring was performed in all the patients. Correlation analysis was made between coronary artery Gensini score and HRV indexes after PCI. Following up for half a year, we explored the risk factors of MACE by binary Logistic linear regression of the incidence of MACE and HRV indexes. Results In the research group SDNN, LF and SD2 are significantly increased compared with those in the control group (P＜0.05) while rMSSD and SD1 are significantly decreased (P<0.05); HF, ApEn and SampEn do not vary sig nificantly from those in the control group (P＞0.05). The indexes of SDNN, rMSSD, LF, HF, SD1 and SD2 after PCI are all significantly lower than those before PCI (P＜0.05) while ApEn and SampEn show no significant difference before and after PCI (P＞0.05). Pearson correlation analysis shows that coronary artery Gensini score of patients is unrelated to SDNN, rMSSD, LF, HF, SD1, SD2 and ApEn (P＞0.05). Binary Logistic regression analysis reveals that LF and SD2 are risk factors of MACE (P＜0.05). Conclusion Autonomic modulation is improved in ACS patients after PCI. HRV indexes of LF and SD2 could effectively reflect the short-term prognosis after operation.
		2023 Vol. 32 (1): 36-41 [Abstract] ( 40 ) [HTML 1KB] [ PDF 892KB] ( 561 )

	42	Value of heart rate variability in evaluating autonomic nerve function of patients with obstructive sleep apnea syndrome at different ages
		TIAN Feng
		Objective To explore the characteristics of autonomic nerve function changes in patients with obstructive sleep apnea syndrome (OSAS) at different ages. Methods A total of 158 OSAS patients were selected, and divided into the young group (<40 years old, 38 cases), the middle-aged group (40-70 years old, 56 cases), and the elderly group (>70 years old, 64 cases) according to different ages. We selected 40 patients without OSAS who had been hospitalized during the same period as the control group. Patients in each group performed 24-hour ambulatory electrocardiography (AECG) monitoring. We recorded heart rate variability (HRV) time-domain indexes [standard deviation of all normal to normal RR intervals (SDNNDay, SDNNNight), standard deviation of all 5 minute normal RR intervals (SDANNDay, SDANNNight) and root mean square of successive differences in RR interval (rMSSDDay, rMSSDNight)\], and HRV frequencydomain indexes [low frequency power (LFDay, LFNight), high frequency power (HFDay, HFNight) and ratio of low frequency power to high frequency power (LFDay/HFDay, LFNight/HFNight)]. Results Neck circumference and body mass index in the elderly group are significantly higher than those in other groups (P<0.05). Apnea hypopnea index (AHI) in the young group is significantly higher than that in the control group; AHI in the middle-aged group is significantly higher than that in the control group and the young group; AHI in the elderly group is significantly higher than that in other groups (P<0.05). SDNNDay, SDNNNight, SDANNDay, SDANNNight, LFDay, LFNight, HFDay, LFDay/HFDay and LFNight/HFNight in the young, the middle-aged and the elderly group are significantly higher than those in the control group while rMSSDDay, rMSSDNight and HFNight are significantly lower than those in the control group (P<0.05). SDNNDay, SDNNNight, SDANNDay, SDANNNight, LFDay, LFNight, HFDay, LFDay/HFDay, LFNight/HFNight in the middle-aged group and the elderly group are significantly higher than those in the young group while rMSSDDay, rMSSDNight and HFNight are significantly lower than those in the young group (P<0.05). LFDay in the elderly group is significantly higher than that in the middle-aged group while HFNight is significantly lower than that in the middle-aged group (P<0.05). The incidence of arrhythmia in the middle-aged group and the elderly group is significantly higher than that in the young group while the incidence of arrhythmia in the elderly group is significantly higher than that in the middle-aged group (P<0.05). Pearson correlation analysis shows that the age of OSAS patients is positively correlated with SDNNDay, SDNNNight, SDANNDay, SDANNNight, LFDay, LFNight and HFDay, and is negatively correlated with rMSSDDay, rMSSDNight and HFNight. Conclusion The sympathetic nerve activity increases and the vagus nerve activity decreases among OSAS patients with age, and the imbalance between the sympathetic nerve and the vagus nerve becomes more obvious. AECG monitoring of HRV has guiding significance for the prevention and treatment of cardiovascular complications.
		2023 Vol. 32 (1): 42-46 [Abstract] ( 33 ) [HTML 1KB] [ PDF 868KB] ( 683 )

	47	Heart rate variability response to head-up tilt test in middle-aged population with different risks of atherosclerotic cardiovascular disease
		ZHUO Minbin, ZHANG Yan, JIANG Ting, OUYANG Yu, LI Chuanchuan
		Objective To compare the heart rate variability (HRV) response to head-up tilt test (HUTT) among middle-aged population with different risks of atherosclerotic cardiovascular disease (ACD). Methods We selected 200 subjects who had undergone HUTT. They were divided into three groups according to the risk of ACD: lowrisk group (n=65), medium-risk group (n=66) and high-risk group (n=69). Each group performed HUTT, and worn the Polar watch throughout the whole process to record HRV indexes including standardized low frequency value (LFnorm) and standardized high frequency value (HFnorm). Results From a supine resting state to an upright position during 25minute HUTT, LFnorm in the high-risk group is significantly higher than that in other two groups while LFnorm in the medium-risk group is also significantly higher than that in the low-risk group (P<0.05); HFnorm in the high-risk group is significantly lower than that in other two groups while HFnorm in the medium-risk group is significantly lower than that in the low-risk group (P<0.05). From a supine resting state to an upright position during 25minute HUTT, LFnorm either in the males or females of the three groups all tends to increase; LFnorm in the high-risk group is significantly higher than that in other two groups while LFnorm in the medium-risk group is also significantly higher than that in the low-risk group (P<0.05). HFnorm either in the males or females of the three groups shows a downward trend during the test; HFnorm in the high-risk group is significantly lower than that in other two groups while HFnorm in the medium-risk group is also significantly lower than that in the low-risk group (P<0.05). Conclusion Patients at a high risk of ACD have problems of autonomic nerve function imbalance after position change from a supine resting state to an upright position during HUTT. The imbalance is mainly manifested by strengthened modulation function of the sympathetic nerve and weakened modulation function of the vagus nerve. It implies that HRV is significantly associated with the risk of cardiovascular diseases.
		2023 Vol. 32 (1): 47-51 [Abstract] ( 35 ) [HTML 1KB] [ PDF 2031KB] ( 626 )

	52	Research progress of subclinical atrial fibrillation
		ADILI Youlituzi, ABULIMITI Subinuer, YAO Juan, GAO Jie
		Subclinical atrial fibrillation (SCAF) refers to atrial fibrillation with no or almost no symptoms which occurs in a subclinical form. It is detected by the programming of cardiac implantable electronic devices (CIED). In recent years, with the development of CIED, SCAF has gradually been recognized by scholars, and become the focus of research. This article mainly reviews the latest progress in aspects of screening methods, risk of stroke and therapy of SCAF.
		2023 Vol. 32 (1): 52-55 [Abstract] ( 46 ) [HTML 1KB] [ PDF 881KB] ( 616 )

	56	Application of high power short duration ablation in treating atrial fibrillation
		DU Hui, MA Yibo, WANG Yi, YI Fu
		Compared with traditional ablation procedures, high power short duration (HPSD) ablation significantly shortens the operation time, discharge time and fluoroscopy time, and reduces the incidence of periprocedural complications. HPSD ablation could not only maintain a high surgical success rate, but also would not increase the incidence of serious complications such as esophageal injury. It is characterized by high efficiency, high safety and low operation difficulty. In recent years, very high power short duration (vHPSD) ablation (90 W, 4 s) has been gradually introduced into clinical diagnosis and treatment, preliminarily showing its high safety and efficacy. With the development of new procedural methods and wide application of hybrid procedure, HPSD ablation may become the main means of rhythm control in patients with atrial fibrillation. This article reviews the clinical application and related progress of HPSD ablation.
		2023 Vol. 32 (1): 56-59 [Abstract] ( 41 ) [HTML 1KB] [ PDF 895KB] ( 602 )

	60	Treatment of atrial fibrillation complicating stable coronary artery disease: Long-term single anticoagulation or combined antiplatelet therapy?
		WANG Lina， LEI Jingshu， LI Kuibao， ZHAO Jingtao， TAN Chen
		How to determine the antithrombotic strength in patients with atrial fibrillation (AF) complicating stable coronary artery disease (SCAD) after one year has always been a clinical challenge and a controversial issue. In the past, most of these people were considered to take longterm single anticoagulation, however the related evidencebased medicine evidences were not sufficient. At present, it is recommended that individualized and accurate management should be performed according to the risk stratification of ischemia and bleeding. Not only should the embolization score of AF be evaluated, but the complexity of the coronary artery disease should also be evaluated. The CHA2DS2VASc, SYNTAX Ⅱ and DAPT scores should be combined to comprehensively assess the ischemic risk of individuals while the HASBLED or BARC score should be combined to assess the bleeding risk for antithrombotic stratified management and dynamic evaluation. Anticoagulation combined with antiplatelet dual pathway inhibition can be given to the population with high ischemia risk and low bleeding risk. Longterm single anticoagulant therapy is suggested to be given to the population with low ischemia risk and high bleeding risk. This article mainly discusses the optimal antithrombotic strategy for patients with AF complicating SCAD after one year.
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