The Study Of AECG With T-RR Plot Of Normal Sinus Rhythm And Cardiac Arrhythmia

Background and ObjectiveAmbulatory electrocardiogram(AECG),which can reflect the major heartrhythm and the style of cardiac arrhythmia by recording the long-term cardiacelectromagnetic activity,is the most common test to assess cardiac arrhythmiaqualitatively and quantitatively. However, it is a time-consuming and painful work toanalyze cardiac arrhythmia because of long recording time and hundreds of thousandsof heart beats. Unlike AECG, electrocardiogram(ECG) scatterplot display theoverall long-term RR intervals according to the dynamic variation rule of RRintervals. It is a faster way to diagnose the cardiac arrhythmia than AECG obviously,especially for large sample data.ECG scatterplot consist of the plots which represent the continuous ECG activityspatial track. It derives from mathematics,computer technology andelectrocardiology. Similar heart beats gather in the same area of the scatterplot andform different points group. There are RR-Lorenz plot, t-RR plot and modifiedPoincaré plot. Here we introduce the t-RR plot only. The t-RR plot is a two-dimensional coordinate system made of numbers of plots whose horizontal andlongitudinal axis is time of R wave and RR interval with the adjacent R waverespectively. It is a obvious disadvantage of RR-Lorenz plot that there is no recordof time when the plot appear, so we cannot obtain the heart rhythm.As we all know,the heart rhythm is associated with appearance time. Fortunately, the t-RR plotmakes up for the RR-Lorenz plot by bringing the appearance time of the plot.There are few reports of big size sample of arrhythmia diagnosed with t-RR plot,we only find a report that combined a few cases of t-RR plot just described thecases. As a consequence,the target of the study is to obtain the diagnostic evidenceof the t-RR plot through comparing the character of plot between the normal sinusrhythm and the cardiac arrhythmia and analyzing the formation mechanism. I hope itis helpful to the electrocardiogram doctors to interpret the AECG quickly andpromptly. At the same time, I also hope that this study can help to enhance theaccuracy of the arrhythmia diagnose and avoid missed diagnosis and misdiagnosis.Materials and Methods1. Participants:The database are patients(n=10900) from our hospital from June2004to June2012,from which I screened3215cases who was diagnosed normal sinus rhythm andthe cardiac arrhythmia, and then I divided the objects into8groups.(1)Single Premature Atrial Contractions (PACs)(n=750): atrial premature contraction(men(n=235); women(n=190)), ventricular premature contraction(men(n=325);women(n=175));(2) Premature atrial contraction along with Bigeminy (n=550):atrial premature contraction along with Bigeminy(men(n=157); women(n=123)),ventricular premature contraction along with Bigeminy(men(n=133);women(n=137));(3) Atrial tachycardia(n=435): men(n=235),women (n=210);(4)Atrial flutter(men(n=18);women(n=12))(5) Paroxysmal atrial fibrillation(n=80:men(n=64),women(n=16);(6) Persistent atrial fibrillation (n=280:men(n=192),women(n=88);(7) Persistent atrial fibrillation along with atrioventricularblock(n=20:men(n=16);women(n=4));(8)Pacemaker(n=80:men(n=64),women(n=16).We also choose980Normal sinus rhythm as the normal control which contain542men and438women.2. Instrument and method:All the groups RR-Lorenz plots was operated with the DMS software(ECGLABHOLTER12.TOP, DMS software limited corporation, Beijing, China)and AECG Analsis analytical instrument(Baihui,Hangzhou,China). Observe the characters of all kinds of t-RR plots (n=10900) classified according to the diagnosisresult.3. Statistical methodsAssociations between categorical variables were tested by use of contingencytables and the χ2test. Continuous variables were given as means±SDs. Comparisonsbetween groups with respect to continuous variables were performed by the t test. Alldata analyses were conducted using SPSS(version17.0) software.All statistical testswere2tailed, with P <0.05used as the significance level.Results1. Statistical analysis:There are significant difference between the sex ratio among the specific atrialfibrillation(p<0.05).2. t-RR Plot(1) When the patients is normal sinus rhythm, the upper and lower limb of thestripe of the t-RR plot look like burr and display a day and night variation.(2) When the patients is Premature Atrial Contractions, the stripe is layered.Thenumber of the strips are the same with the number of RR intervals. The day and nightvariation is disappear when atrioventricular block happens.(3) Atrioventricular block: The stripe of the I degree is narrow; there are twostripes when II style of II degree happens; while the upper limber is flat of the Ⅲdegree.(4) Atrial tachycardia display4layers, namely from the top to the bottom, theyare like spot, string, and dense line respectively.(5) There is no layered,but widen stripe when atrial fibrillation happens.Thelower limb is flat.(6) When the patients suffered from PAf, the t-RR plot includes two parts, thesinus rhythm and Af. The part of sinus rhythm was a unstratified and dense bold linewhich the upper and lower edge was burr shape. However, the another part shows abroadened band with a dense lower edge and sparse upper edge. The edge of stripwith boundaries.(7) When the patients suffered from atrial fibrillation along with atrioventricular block, there is a obvious upper limit within1.5~1.8second, while the lower limb likespot or cloudy.(8) The plot of pacemaker without specific function:There is no obvious layersin the plot, it is a steel line when24h is complete pacing rthym,.On the contrary,it isa dense string which a obvious limit and the lower limb is burr shape.ConclusionThrough the analysis of large sample AECG t-RR plot, we can find and confirmthe different characters between normal sinus rhythm and cardiac arrhythmia.According to these characteristics,we can quickly identify arrhythmia types, whichfacilitate electrocardiogram doctors to diagnose the arrhythmia intuitively, rapidly,qualitatively and quantitatively. It also can improve the accuracy, avoid misseddiagnosis and misdiagnosis, and provide clinical basis for the diagnosis and treatmentfor diseases. However,t-RR plot also has disadvantage, when cardiac arrhythmia isnot a massive cardiac data,the method does not work.