Discussion Between Circadian Rhythm Of Arrhythmias In Coronary Heart Disease And Zi Wu Liu Zhu Time Rule

Objective1. To discuss on the relationship between circadian rhythm ofarrhythmias in coronary heart disease and Zi wu liu zhu time rule.2. To judge influential factors for arrhythmias in coronary heartdisease with statistical model.MethodThis study is based on data analysis. Specific schedule is made tofill in original medical information among patients who were diagnosedas coronary heart disease(CHD) and had 24 hours dynamicelectrocardiogram(DEC) examination in GuangDong Hosiptal of TCM fromFebruary 2002 to August 2006, Which include clinical data, DEC andechocardiography results. CHDdiagnostic code follows the 6th edition ofinternal medicine compiled by Ye Rengao and Lu Zaying. While TCMclassification is from 1st edition of chinese internal medicine, writtenby Zhou Zhongying. There are 9 types of TCM classification, cariac bloodstasis, qi excess heart and thorax, sputum blockage, invasion ofpathogenic cold into the cardiovascular, deficiency of both qi and yin,yin asthenia of both heart and kidney, asthenia of healthy energy andyang-exhausted pulse, qi deficiency and blood stasis. To assess samplecontent based on various sample content assessment principle. The timestandard, Zi wu liu zhu time rule- circadian rhythm, 24-hour timing methodall originated from Zi wu 1iu zhu Shuo Ao, written by Chen Shutang.Establish in—standard and out—standard, collect and input data to setup an EXCEL database. 9 types of TCM classification fall into 3 syndromes,deficient syndrome, excess syndrome, syndrome includes excess anddeficiency, or 2 syndromes, yin syndrome and yang syndrome. Record thepatients' 24-hour circadian rhythm of electrocardiogram in circle distribution. Take 24-hour as 360°by PEMS3.1 and microcomputer, convertangles by hours, analyze the average angle in the cirle recording generalsamples and all groups of samples, and make hypothesis verification. Judgethe influential factors for ventricular premature beat(VPB) in coronaryheart disease by SPSS13.0 binary state variable and order Logisticregression analysis. Using interclass correlation analysis andcorrelation coefficient to demonstrate the relationship betweenventricular premature beat and other ventricular arrhythmia(VA),supraventricular premature beat(SPB) and other atrial arrhythmia(AA).Show the frequency line chart of arrhythmias by EXCEL, directly showingthe actual frequency.Results1. General state 520 samples, 265 males and 255 females, rangefrom 36 to 103 years old. The average age is 71.45±0.87. TCMclassification: deficient syndrome 27 samples, 5.19％; excess syndrome,388 samples, 74. 62％; syndrome includes excess and deficiency, 105samples, 20.19％. cariac blood stasis, 472samples, 90.77％; yin syndrome,133samples, 25.58％in total: yang syndrome, 387samples, 74.42％. Atrialpremature beat(APB) and VPBare two most frequent arrhythmias in coronaryheart disease, with auricular tachycardia(AT) as the third.2. Circle distribution analysis Peak time for various arrhythmiaamong 520 samples from coronary disease patients, 133 yin syndrome samples,387 yang syndrome samples, 472 cariac blood stasis samples, 27 deficientsyndrome samples, 388 excess syndrome samples and 105 syndrome includesexcess and deficiency samples, is around 0:30:00, Zi hour, which is thefirst of the twelve Earthly Branches, from llpm to lam. The lowest timefor VPB, VPB-Pair, supraventricular premature beats (SPB) andsupraventricular tachycardia (ST) is in Si hour, 9-11am.3. Multivariate analysis Analyze factors like gender, age,patient history, the use of antiarrhythmic drugs, smoking, drinking, EFdata and E/A relative value to find link between them and VPB.(1) Binary state variable Logistic regression analysis on VPBFactors as deficiency syndrome, the use of Betaloc and Digoxin,end-systolic volume(ESV) enter the equation. Deficiency syndrome, theuse of Betaloc and Digoxin can reduce the occurrence of VPB. Dangerous factor for VPB is ESV.(2)Order Logistic regression analysis on VPB Parameters enteringthe model, ESV, deficiency syndrome and the use of Betaloc. The resultshows, ESV adds the occurrence of VPB but others prevent it.4. Correlation analysis All types of arrhythmias show a skeweddistribution. Actually there is mutual relationship on different timespot separately between VPB and VPB-pair, VT, ventricular bigeminy,ventricular trigemiay, which are worked out by Spearman sank correlationanalysis with correlation coefficients from 0.172 to 0.403. It's samefor relationship among SPB, arial bigeminy and atrial trigemiay, withcorrelation coefficients from 0.224 to 0.449.5. Frequency line chart of arrhythmia Based on the frequency ofdifferent arrhythmias, make line chart to show the lowest time slot.According to the chart, the lowest time for VPB and VPB-Pair is in Si hour,9-11am. So does SPB and ST.ConclusionThis study confirms that, for circadian rhythm of arrhythmias incoronary heart disease, the peak time is Zi hour while the lowest timeis Si hour. Multivariate analysis shows ESV for cases adds the occurrenceof VPB. By improving the inhibition of sympathetic excitement, the useof Betaloc is protective factors for arrhythmias in coronary heart disease.The core result conforms to TCM chronomedicine theory that "the cardiacpatiens feel surgeless in the morning, day is better while night is worse",which is proved to be true in science. The result combines modern Holterelectrocardiographic indicators, Zi wu liu zhu time rule and zangfusyndrome differentiation. This study proves Chinese chronomedicine to beture in science. Modern means of medical examination provide help forstudies on chinese chronomedicine.Though the result we concluded is in contrast with the report abroad,that serious heart attack incident express a "morning peak" phenomenon.The two are not in contradiction but concordant. Does it tell somethingfor serious coronary heart disease incidence by this peak time conclusion?Arrhythmias in coronary heart disease doesn't mean the aura of seriouscoronary heart disease incidence, but a prediction and internal basis.This provides a new way- "following the prognosis of a disease" for clinical treatment. The new way provides scientific basis for working outa more reasonable treatment programs to reduce serious coronary heartdisease incidence.