| Object:The aim of this paper is to look and sum up the features of ECG waterfall map and Lorenz scatter plot of atrioventricular block,combine them to diagnose atrioventricular block,and compare them with the orthodox 24-hour dynamic electrocardiogram in the diagnosis of atrioventricular block,in order to find out the advantages of the two diagnostic methods.To discuss the application value of ECG waterfall and Lorenz scatter plot in the diagnosis of atrioventricular block,and to provide a new method for the diagnosis of atrioventricular block.Methods:Via the American DMS12.5.0076 a edition of the dynamic electrocardiogram,and lorenz scatter plot,ECG waterfall diagram analysis system,a retrospective analysis of the 12-channel dynamic electrocardiogram recording box collected from March,2020 to October,2022 in the First Affiliated Hospital of Dali University electrocardiogram room 24 h dynamic electrocardiogram examination of patients with continuous 24 h dynamic electrocardiogram and ECG waterfall plot and lorenz scatter plot,the specific analysis includes :(1)The characteristics of ECG waterfall and Lorenz scatter plot of atrioventricular block;(2)By comparing with24-hour dynamic electrocardiogram,the advantages of ECG waterfall and Lorenz scatter plot in the diagnosis of atrioventricular block were summarized.(3)The sensitivity,specificity,veracity,positive predictive value and negative predictive value of ECG waterfall and lorenz scatter plot in the diagnosis of atrioventricular block were analyzed.The analysis data were analyzed by SPSS26.0software.The measurement data were expressed by(x ± s),and the count data were expressed by n(%).The results of ECG waterfall diagram and lorenz scatter plot were consistent with the artificial diagnosis of 24 h dynamic electrocardiogram to obtain Kappa value,and then Mc Nemar test was performed.P <0.0 5 i n d i c a t e d t h a t t h e d i f f e r e n c e w a s s t a t i s t i c a l l y s i g n i f i c a n t.Results:1.A total of 175 cases were included,cover 118 males(67.43 %)and 57 females(32.57 %),with a male to female ratio of about 2.07 : 1.The age of the selected cases was between 1.4 years old and 90 years old,with an average age of(64.21 ± 0.51)years old,including 9 cases of 1 year old to 25 years old,22 cases of 26 to 50 years old,96 cases of 51 to 75 years old,and 48 cases of 76 years old and above(27.43 %).There were 60 cases(34.29 %)of first degree atrioventricular block,45cases(25.71 %)of second degree type I atrioventricular block,35 cases(20.00 %)of second degree type II atrioventricular block and 35 cases(20.00 %)of third degree atrioventricular block.2.The characteristics of ECG waterfall map of different clinical types of atrioventricular block : 1)One degree atrioventricular block : the distance between P peak and R peak is widened.2)The characteristic manifestations of ECG waterfall diagram of second-degree type I atrioventricular block : Because atrioventricular block is not a continuous occurrence,the distance between P peak band and R peak band is prolonged during intermittent atrioventricular block.3)The characteristic performance of the second degree II atrioventricular block ECG waterfall diagram : the distance between the P peak band and the R peak band increases,but the P peak band level is basically flat,indicating that the PR interval is prolonged during II degree block,but remains fixed.4)ECG waterfall characteristics during third degree atrioventricular block : During third degree atrioventricular block,the atrioventricular was completely separated,and there was no connection between the P peak band and the R peak band.The P peak band completely disappeared,and a clear and continuous peak band could not be formed.The P peak band shows : irregular rain-like distribution,full-eye haze(scars)or a wisp of blue smoke-like upward movement,irregular scattered graphics can also appear at the same time.3.Lorenz scatter plot characteristics of different clinical types of atrioventricular block : 1)Lorenz scatter plot characteristics analysis of first-degree atrioventricular block : when first-degree atrioventricular block,only the extension of PR interval,not accompanied by the shedding of QRS wave group,the deceleration zone can not form the pre-block point set,and the acceleration zone can not form the post-block point set.The first-degree atrioventricular block still shows a sinus scatter set,which may be a small short stick shape due to the decrease of heart rate variability.2)Lorenz scatter plot characteristics analysis of second-degree type I block : The scatter plot shows a three-distribution pattern,a short rod-shaped sinus rate point set distributed on the45-degree line.The slow deceleration zone distributed the pre-block point set,basically distributed below the y = 2x line,and the slow acceleration zone distributed the post-block point set,roughly distributed above the y = 0.5x line.3)Characteristic analysis of Lorenz scatter plot in second degree type II block : Since the PR interval of second degree type II block is fixed,similar to that of type I block,the scatter plot also presents a three-distribution pattern,which is a short rod-shaped sinus rate point set distributed on the isokinetic line.When atrioventricular block continues throughout the day,it is a two-distribution scatter plot symmetrical about the 45-degree line,that is,the short and long periods of the slow deceleration zone are distributed with a continuous pre-block point set,which is basically distributed on the y = 2x line,and the long and short periods of the slow acceleration zone are distributed with a continuous post-block point set,which is roughly distributed on the y = 0.5x line.4)Analysis of Lorenz scatter plot characteristics during three-degree atrioventricular block : The scatter plot shows a distribution pattern along the 45-degree isokinetic line,and the scatter set tends to the distal segment.The rest of the region has a small amount of sparse non-featured scatter points,and the dominant rhythm(NNN point set)is a short rod,which is distributed vertically at the higher position of the isoline.4.Diagnosis of atrioventricular block by ECG waterfall and lorenz scatter plot:1)The sensitivity,specificity,veracity,positive predictive value and negative predictive value of ECG waterfall map in the diagnosis of first-degree atrioventricular block were83.33 %,98.26 %,93.14 %,96.15 % and 91.86 %,respectively.The consistency between ECG waterfall map and gold standard was good(Kappa = 0.843,P < 0.05).2)The sensitivity,specificity,veracity,positive predictive value and negative predictive value of ECG waterfall map in the diagnosis of second degree atrioventricular block were 83.75 %,97.89 %,91.42 %,97.10 % and 87.74 %,respectively.The consistency between ECG waterfall map and gold standard was good(Kappa = 0.825,P0.05).3)The sensitivity,specificity,veracity,positive predictive value and negative predictive value of ECG waterfall chart in the diagnosis of third-degree atrioventricular block were82.86 %,98.57 %,95.43 %,93.55 % and 95.83 %,respectively.The consistency between ECG waterfall map and gold standard was good(Kappa = 0.851,P0.05).4)The sensitivity,specificity,veracity,positive predictive value and negative predictive value of Lorenz plot in the diagnosis of first-degree atrioventricular block were58.33 %,56.52 %,57.14 %,41.18 % and 72.22 %,respectively.The consistency between Lorenz scatter plot and gold standard was poor(Kappa = 0.135,P < 0.05),and the difference between the two methods was statistically significant(P < 0.05).5)The sensitivity,specificity,veracity,positive predictive value and negative predictive value of Lorenz scatter plot in the diagnosis of second degree type I atrioventricular block were 82.22 %,98.46 %,94.29 %,94.87 % and 94.12 %,respectively.The Lorenz plot was highly consistent with the gold standard(Kappa =0.844,P0.05).6)The sensitivity,specificity,veracity,positive predictive value and negative predictive value of Lorenz scatter plot in the diagnosis of second-degree type II block atrioventricular block were 88.57 %,97.86 %,96.00 %,91.17 % and 97.16 %,respectively.The Lorenz scatter plot was consistent with the gold standard(Kappa =0.851,P0.05).7)The sensitivity,specificity,veracity,positive predictive value and negative predictive value of Lorenz scatter plot in the diagnosis of third degree atrioventricular block were 85.71 %,97.86 %,95.43 %,90.91 % and 96.48 %,respectively.The Lorenz scatter plot was consistent with the gold standard(Kappa =0.854,P0.05).Conclusions:Atrial-ventricular block has its characteristic manifestations in ECG waterfall diagram and lorenz scatter diagram.,and each has its own advantages and disadvantages.The complementarity of the two can diagnose atrioventricular block intuitively,conveniently,accurately and comprehensively,so as to improve the diagnosis rate of atrioventricular block. |
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