云南不明原因猝死重点病区人群心电图调查研究

目的研究云南不明原因猝死重点病区人群的健康状况,探索其与云南不明原因猝死发病之间的关系,为病因学研究、制定有效的干预和临床救治措施提供科学依据。方法选择两个反复发病村、一个新发聚集性病例村和一个对照村作为调查点,连续观察测量研究对象的心电图、血液生化、血压、心率、呼吸频率、体温、身高和体重等健康指标,对比分析各类人群各项指标之间的差异。结果重点病区人群心电图以“U波异常、T波异常、传导阻滞、ST-T改变、Q-T间期延长”等心肌损伤型表现为主,其中“U波异常”检出率高达50．9％,明显区别于对照人群“窦性心律不齐、电轴左偏、低电压”等归属为“正常”的心电图改变类型;大部分相同类型的心电图检出率重点病区人群明显高于对照人群,重点病区人群的BMI超重和消度检出率低于对照人群。结论重点病区人群的心电图改变较为复杂和严重,存在较高的发生恶性心律失常的潜在风险,且反复发病村人群较新发聚集性病例村人群存在的心脏健康风险更高;“Q-T间期延长”可作为发生恶性心律失常的预警指标,心电图和心肌酶可联合作为云南不明原因猝死病区人群的特异性临床检查、检测指标,是制定病例定义和临床救治措施的重要参考指标。     

R波移行导联和V2转换率对流出道起源室性心律失常的定位价值

目的 通过回顾性研究对R波移行导联及V2转换率定位流出道起源的室性心律失常(VA)的流程进行准确性验证,旨在寻找一个简洁准确的方法区分右心室流出道(RVOT)和左心室流出道(LVOT)起源的VA.方法 回顾性分析接受射频导管消融治疗的起源于流出道的VA患者心电图资料,计算R波移行导联及V2转换率,并与射频消融结果相比,验证心电图流程的准确性.结果 52例患者中有24例VA时R波移行≥V4导联,均在RVOT消融成功.10例R波移行≤V2导联患者中,9例在LVOT消融成功.18例R波移行在V3导联的患者中,5例VA时胸前导联移行晚于窦性心律时的患者全部在RVOT消融成功,6例V2转换率＜0.6的患者均在RVOT消融成功,而V2转换率≥0.6的7例患者中,5例在LVOT消融成功,2例在RVOT消融成功.该心电图流程定位结果与射频消融定位结果一致性程度高,Kappa值为0.8627,区分RVOT和LVOT起源的VA的正确指数为0.9211.结论 利用R波移行导联及V2转换率相结合的方法能准确区分RVOT和LVOT起源的VA,R波移行≥V4导联和VA时胸前导联移行晚于窦性心律时能100％除外VA起源于LVOT.     

Normal standards for computer-ECG programs for prognostically and diagnostically important ECG variables derived from a large ethnically diverse female cohort: The Women's Health Initiative (WHI)

Background

Substantial new information has emerged recently about the prognostic value for a variety of new ECG variables. The objective of the present study was to establish reference standards for these novel risk predictors in a large, ethnically diverse cohort of healthy women from the Women's Health Initiative (WHI) study.

Methods and Results

The study population consisted of 36,299 healthy women. Racial differences in rate-adjusted QT end (QT_ea) and QT peak (QT_pa) intervals as linear functions of RR were small, leading to the conclusion that 450 and 390 ms are applicable as thresholds for prolonged and shortened QT_ea and similarly, 365 and 295 ms for prolonged and shortened QT_pa, respectively. As a threshold for increased dispersion of global repolarization (T_peakT_end interval), 110 ms was established for white and Hispanic women and 120 ms for African-American and Asian women. ST elevation and depression values for the monitoring leads of each person with limb electrodes at Mason-Likar positions and chest leads at level of V1 and V2 were first computed from standard leads using lead transformation coefficients derived from 892 body surface maps, and subsequently normal standards were determined for the monitoring leads, including vessel-specific bipolar left anterior descending, left circumflex artery and right coronary artery leads. The results support the choice 150 μV as a tentative threshold for abnormal ST-onset elevation for all monitoring leads. Body mass index (BMI) had a profound effect on Cornell voltage and Sokolow–Lyon voltage in all racial groups and their utility for left ventricular hypertrophy classification remains open.

Conclusions

Common thresholds for all racial groups are applicable for QT_ea, and QT_pa intervals and ST elevation. Race-specific normal standards are required for many other ECG parameters.     

Novel technical solutions for wireless ECG transmission & analysis in the age of the internet cloud

Current guidelines recommend early reperfusion therapy for ST-elevation myocardial infarction (STEMI) within 90 min of first medical encounter. Telecardiology entails the use of advanced communication technologies to transmit the prehospital 12-lead electrocardiogram (ECG) to offsite cardiologists for early triage to the cath lab; which has been shown to dramatically reduce door-to-balloon time and total mortality. However, hospitals often find adopting ECG transmission technologies very challenging. The current review identifies seven major technical challenges of prehospital ECG transmission, including: paramedics inconvenience and transport delay; signal noise and interpretation errors; equipment malfunction and transmission failure; reliability of mobile phone networks; lack of compliance with the standards of digital ECG formats; poor integration with electronic medical records; and costly hardware and software pre-requisite installation. Current and potential solutions to address each of these technical challenges are discussed in details and include: automated ECG transmission protocols; annotatable waveform-based ECGs; optimal routing solutions; and the use of cloud computing systems rather than vendor-specific processing stations. Nevertheless, strategies to monitor transmission effectiveness and patient outcomes are essential to sustain initial gains of implementing ECG transmission technologies.     

Diffuse ST-elevation following J-wave presentation as an uncommon electrocardiogram pattern of Tako-Tsubo cardiomyopathy

Background

Tako-Tsubo cardiomyopathy (TTC) is characterized by symptoms, ECG changes with elevated cardiac markers mimicking acute myocardial infarction, left ventricular (LV) wall motion abnormalities in the apical region with preserved function of base, and normal coronary arteries. Usual ECG anomalies heralding TTC are ST-elevation in anterior leads, QT prolongation and negative T-waves.

Methods

We report the unusual case of TTC with an uncommon ECG presentation: J wave in inferior leads followed by diffuse ST-elevation.

Results

An 82-year-old woman was admitted for dyspnea and chest pain following exacerbation of chronic obstructive pulmonary disease. ECG showed J-wave in inferior leads followed by diffuse ST-elevation. The patient was monitored in intensive care unit and treated with diuretics. Both ECG and echocardiography anomalies gradually recovered.

Conclusions

Diffuse ST-elevation following J-waves may be considered as a possible ECG pattern of presentation in case of TTC.     

Padrão de Brugada em doente medicada com lamotrigina

The authors report the case of a 52-year-old woman with depressive syndrome, treated with lamotrigine for about five months, who went to the emergency department for atypical precordial pain. The electrocardiogram (ECG) revealed a 2-mm downsloping ST-segment elevation and negative T waves in V1 and V2. Due to suspicion of ST-elevation acute coronary syndrome, cardiac catheterization was performed, which revealed normal coronary arteries. The initial ECG was suggestive of type 1 Brugada pattern, but subsequent serial ECGs were less typical. A flecainide test showed the same pattern.After discontinuation of lamotrigine reversal of the typical Brugada ECG pattern was observed.Although not currently contraindicated in Brugada syndrome, the antidepressant lamotrigine blocks sodium channels, which are usually inactivated in heart cell membranes in Brugada syndrome, and may be responsible for the expression of type 1 Brugada pattern.     

Electrocardiographic features of patients with earthquake related posttraumatic stress disorder

AIM: To analyze electrocardiographic features of patients diagnosed with posttraumatic stress disorder (PTSD) after the Van-Erci earthquake, with a shock measuring 7.2 on the Richter scale that took place in Turkey in October 2011. METHODS: Surface electrocardiograms of 12 patients with PTSD admitted to Van Erci State Hospital (Van, Turkey) from February 2012 to May 2012 were examined. Psychiatric interviews of the sex and age matched control subjects, who had experienced the earthquake, confirmed the absence of any known diagnosable psychiatric conditions in the control group. RESULTS: A wide range of electrocardiogram (ECG) parameters, such as P-wave dispersion, QT dispersion, QT interval, Tpeak to Tend interval, intrinsicoid deflection durations and other traditional parameters were similar in both groups. There was no one with an abnormal P wave axis, short or long PR interval, longor short QT interval, negative T wave in lateral leads, abnormal T wave axis, abnormal left or right intrinsicoid deflection duration, low voltage, left bundle branch block, right bundle branch block, left posterior hemiblock, left or right axis deviation, left ventricular hypertrophy, right or left atrial enlargement and pathological q(Q) wave in either group. CONCLUSION: The study showed no direct effect of earthquake related PTSD on surface ECG in young patients. So, we propose that PTSD has no direct effect on surface ECG but may cause electrocardiographic changes indirectly by triggering atherosclerosis and/or contributing to the ongoing atherosclerotic process.     

心电图动态观察对急性左心衰患者的预后评价

目的探讨心电图QRS波时限和Q—TC间期以及二者的动态变化对急性左心衰竭（ALHF）患者的预后评价。方法选择2008年6月～2011年6月广东省深圳市宝安区中医院就诊的ALHF患者176例,在急性发作,6h内及首检后24、72h行常规心电图检查,测量QRS波时限及Q—TC间期,并计算其首检后24、72h的变化率。依据患者出院情况分为预后良好组（n=86）、预后不良组（n=59）和死亡组（n=31）,分析三组患者各时点QRS波时限和Q—TC间期及变化率,以评价其预测作用。结果预后良好组首检后24、72h的QRS波时限、Q—TC间期较急性发作6h内下降,各时点之间比较,差异有统计学意义（P〈0．05）,其余两组组内各时点QRS波时限及Q—TC间期变化差异无统计学意义（P〉0．05）;预后不良组及死亡组首检后24h的Q—TC间期及首检后72h的QaS波时限、Q—TC间期长于预后良好组,差异有统计学意义（P〈0．05）;预后不良组、死亡组的RATEQ—RS垒、RATEQ-RS3、RATEQ-Tc2、RATEQ-Tc3与预后良好组比较,差异均有统计学意义（均P〈0．05）;预后不良组与死亡组的RATEQ-RS2、RATEQ-RS3、RATEQ-Tc3比较,差异无统计学意义（P〉0．05）,两组RATEQ-Tc2比较差异有统计学意义（P〈0．05）。结论多时点的QRS波时限、Q—TC间期以及二者的变化率能较好的预测ALHF患者的预后。     

50例扩张型心肌病的临床心电图分析

目的总结扩张型心肌病（DCM）的心电图表现,为其临床诊断提供参考依据。方法50例扩张型心肌病患者均行标准12导联心电图检查,观察DCM患者的心电图情况,同时选择同期健康体检者50名设为对照组,对比分析两组的P—R间期,QRS时限、QTc情况。结果DCM患者心电图主要为心律失常,包括异位搏动及异位心律、传导阻滞、房室肥大及心率改变等。其中DCM组的QRS时间及Q—T间期、QTc分别高于对照组,差异有统计学意义（P〈0．05）。结论DCM心电图有多方面的异常表现,与病情严重程度密切有关,常规心电图检查简便、经济、快捷。为扩张型心肌病的诊断提供了有效的参考依据。