**Meet the editor**

The author teaches physiology at The Howard University College of Medicine. He has authored/co-authored more than 70 scientific articles. His research on obesity,identified physiological correlates of heart rate variability. His report on nicotine played a crucial role in the development of the first smoke-free workplace in the US federal government. He developed the first database on antidotes to chemical

and biological warfare agents, the first curriculum used to train physicians on chemical casualty care for the Persian Gulf War,and the first minority neuroscience fellowship program sponsored by the international Society for Neuroscience. He served as an evaluator for the National Institute of Mental Health's Advocacy for Individuals with Mental Illness program, and as a consultant at the National Institute of Drug Abuse on AIDS cofactors. He also helped with the development of the first doctor assistant training program in sub-Saharan Africa,Ethiopia, as well as biomedical curricula for the National University of Rwanda after the execution of many of it's professors during the Rwandan genocide.

Contents

**Preface IX** 

**Part 1 Cardiac Arrhythmias 1** 

Chapter 1 **The Prognostic Role of ECG** 

Chapter 2 **Electrocardiographic QT Interval** 

**in Arterial Hypertension 3** 

**Prolongation in Subjects With and Without Type 2 Diabetes** 

and Gonzalez-Villalpando Clicerio

Chapter 4 **Arrhythmias in Children and Young Adults 41** 

Chapter 6 **Electrocardiograms in Acute Pericarditis 83** 

Chapter 7 **The Remodeling of Connexins Localized at** 

Guo-qiang Zhong, Ri-xin Xiong, Hong-xing Song, Yun Ling, Jing-chang Zhang and Zhe Wei

**Reveals More than What It Conceals 77** 

Anita Radhakrishnan and Jerome E. Granato

**Pulmonary Vein – Left Atria in Triggering and Maintenance of Atrial Fibrillation 95** 

Chapter 3 **The Prevalence and Prognostic Value of** 

Harinder R. Singh

Chapter 5 **Paced ECG Morphology –** 

Ajay Bahl

Stavros Dimopoulos, Christos Manetos,

Eleni Koroboki, John Terrovitis and Serafim Nanas

**– Risk Factors and Clinical Implications 13**  Jimenez-Corona Aida, Jimenez-Corona Maria Eugenia

**Rest Premature Ventricular Contractions 27**  Matthew D. Solomon and Victor Froelicher

### Contents



Jing-chang Zhang and Zhe Wei

#### X Contents

### **Part 2 Myocardial Infarction 111**  Chapter 8 **ECG in Acute Myocardial Infarction in the Reperfusion Era 113**  Massimo Napodano and Catia Paganelli Chapter 9 **Mechanisms of Postinfarction Electrophysiological Abnormality: Sympathetic Neural Remodeling, Electrical Remodeling and Gap Junction Remodeling 133**  Guoqiang Zhong, Jinyi Li, Honghong Ke, Yan He, Weiyan Xu and Yanmei Zhao Chapter 10 **Novel Porcine Models of Myocardial Ischemia/Infarction – Technical Progress, Modified Electrocardiograms Validating, and Future Application 175**  Jianxun Liu and Xinzhi Li **Part 3 Autonomic Dysregulation 191**  Chapter 11 **The Emergence and Development of Physiological Regulatory Systems of Newborn Infants in a Neonatal Intensive Care Unit 193**  Motoki Bonno, Esmot Ara Begum and Hatsumi Yamamoto Chapter 12 **Automated Detection and Classification of Sleep Apnea Types Using Electrocardiogram (ECG) and Electroencephalogram (EEG) Features 211**  Onur Kocak, Tuncay Bayrak, Aykut Erdamar, Levent Ozparlak, Ziya Telatar and Osman Erogul Chapter 13 **Low Heart Rate Variability in Healthy Young Adult Males 231**  Richard M. Millis, Stanley P. Carlyle, Mark D. Hatcher and Vernon Bond Chapter 14 **The Role of Exercise Test After Percutaneous Coronary Intervention 245**  Iveta Mintale, Milana Zabunova, Dace Lurina, Inga Narbute, Sanda Jegere, Ilja Zakke, Vilnis Taluts Dzerve and Andrejs Erglis

Contents VII

Chapter 16 **Electrocardiogram (ECG) Abnormality Among** 

Chapter 17 **Abnormal Electrocardiogram in Patients**

**Residents in Arseniasis-Endemic and Non-Endemic** 

**with Acute Aluminum Phosphide Poisoning 319** 

**of Gene-Gene and Gene-Environment Interactions 297** 

**Areas of Southwestern Taiwan – A Study** 

Ya-Tang Liao, Wan-Fen Li, Chien-Jen Chen, Wei J. Chen, Hsiao-Yen Chen and Shu-Li Wang

Amine Ali Zeggwagh and Maha Louriz

### **Part 4 Cardiotoxicology 269**

### Chapter 15 **Toxic and Drug-Induced Changes of the Electrocardiogram 271**  Catalina Lionte, Cristina Bologa and Laurentiu Sorodoc


VI Contents

**Part 2 Myocardial Infarction 111** 

Chapter 9 **Mechanisms of Postinfarction** 

Jianxun Liu and Xinzhi Li

**Part 3 Autonomic Dysregulation 191** 

Chapter 11 **The Emergence and Development** 

Chapter 13 **Low Heart Rate Variability in** 

Chapter 14 **The Role of Exercise Test After**

**Part 4 Cardiotoxicology 269** 

Chapter 15 **Toxic and Drug-Induced**

**Infarction in the Reperfusion Era 113** Massimo Napodano and Catia Paganelli

**Electrophysiological Abnormality:** 

Guoqiang Zhong, Jinyi Li, Honghong Ke, Yan He, Weiyan Xu and Yanmei Zhao

**Sympathetic Neural Remodeling, Electrical Remodeling and Gap Junction Remodeling 133** 

Chapter 10 **Novel Porcine Models of Myocardial Ischemia/Infarction – Technical Progress, Modified Electrocardiograms**

**Validating, and Future Application 175** 

**of Physiological Regulatory Systems** 

Chapter 12 **Automated Detection and Classification of** 

**Healthy Young Adult Males 231**  Richard M. Millis, Stanley P. Carlyle, Mark D. Hatcher and Vernon Bond

**Percutaneous Coronary Intervention 245** Iveta Mintale, Milana Zabunova, Dace Lurina, Inga Narbute, Sanda Jegere, Ilja Zakke, Vilnis Taluts Dzerve and Andrejs Erglis

**Changes of the Electrocardiogram 271** 

Catalina Lionte, Cristina Bologa and Laurentiu Sorodoc

**of Newborn Infants in a Neonatal Intensive Care Unit 193**  Motoki Bonno, Esmot Ara Begum and Hatsumi Yamamoto

**Sleep Apnea Types Using Electrocardiogram (ECG) and Electroencephalogram (EEG) Features 211** Onur Kocak, Tuncay Bayrak, Aykut Erdamar, Levent Ozparlak, Ziya Telatar and Osman Erogul

Chapter 8 **ECG in Acute Myocardial** 

Preface

chambers of the heart.

A number of heart diseases in humans are rooted in the structure-function relationships of the lower animal hearts. These relations are observable during human embryonic organogenesis. The hearts of invertebrates and lower vertebrates are similar to the embryonic tubular hearts of higher vertebrates. These primitive ancestral hearts possess cardiac myocytes that are electrically coupled by gap junctions such as those in mammalian and human hearts. The highest pacemaker activity occurs at the receiving end of the primitive ancestral heart, thereby, resulting in waves of peristaltic contractions similar to those in gastrointestinal tracts. This tubular arrangement gives rise to atrial and ventricular chambers with well-developed and well-coupled cardiac myocytes with low pacemaker activity, producing the rapid conduction and contraction of mammalian and human hearts. The forming chambers are made up of rapidly proliferating myocytes with a surrounding area of slowly proliferating trabecular myocardium. This slowly proliferating trabecular myocardium does not differentiate into normal myocardium of the heart chambers because it remains poorly developed. The tightly coupled electrically by highly organized gap junctions and intercalated discs give rise to the ventricular conduction system. Thus, the human ventricular conduction system arises from the embryonic myocardium, and permits rapid conduction of cardiac excitation, and subsequent contraction of the pumping

In contrast, to vertebrates, many invertebrates lack an autonomic nervous system for organizing cardiac signaling and insuring responsiveness to a wide variety of complex physiological stimuli. In lower vertebrates, the vagus nerve arises from the brain as a cranial nerve and innervates the pacemaker cells of the heart. When stimulated, the vagus slows the rate at which the cardiac phases of depolarization and repolarization are produced. In higher vertebrates with well- developed heart chambers, specialized for receiving (atria) and pumping (ventricles), the atrial pacemaker cells are innervated by vagal parasympathetic, as well as by sympathetic nerve fibers. This arrangement appears to subserve sophisticated tuning of the heart rate, and pumping activity (contractility) to immediate changes in the physiological state of the animal, insuring adequate flow of nutrients to the various tissue compartments, especially to the complex brains and other vital organs of mammals. In mammals, vagal innervation of pacemaker cells in the sinoatrial node appears to arise from two main sources, the

### Preface

A number of heart diseases in humans are rooted in the structure-function relationships of the lower animal hearts. These relations are observable during human embryonic organogenesis. The hearts of invertebrates and lower vertebrates are similar to the embryonic tubular hearts of higher vertebrates. These primitive ancestral hearts possess cardiac myocytes that are electrically coupled by gap junctions such as those in mammalian and human hearts. The highest pacemaker activity occurs at the receiving end of the primitive ancestral heart, thereby, resulting in waves of peristaltic contractions similar to those in gastrointestinal tracts. This tubular arrangement gives rise to atrial and ventricular chambers with well-developed and well-coupled cardiac myocytes with low pacemaker activity, producing the rapid conduction and contraction of mammalian and human hearts. The forming chambers are made up of rapidly proliferating myocytes with a surrounding area of slowly proliferating trabecular myocardium. This slowly proliferating trabecular myocardium does not differentiate into normal myocardium of the heart chambers because it remains poorly developed. The tightly coupled electrically by highly organized gap junctions and intercalated discs give rise to the ventricular conduction system. Thus, the human ventricular conduction system arises from the embryonic myocardium, and permits rapid conduction of cardiac excitation, and subsequent contraction of the pumping chambers of the heart.

In contrast, to vertebrates, many invertebrates lack an autonomic nervous system for organizing cardiac signaling and insuring responsiveness to a wide variety of complex physiological stimuli. In lower vertebrates, the vagus nerve arises from the brain as a cranial nerve and innervates the pacemaker cells of the heart. When stimulated, the vagus slows the rate at which the cardiac phases of depolarization and repolarization are produced. In higher vertebrates with well- developed heart chambers, specialized for receiving (atria) and pumping (ventricles), the atrial pacemaker cells are innervated by vagal parasympathetic, as well as by sympathetic nerve fibers. This arrangement appears to subserve sophisticated tuning of the heart rate, and pumping activity (contractility) to immediate changes in the physiological state of the animal, insuring adequate flow of nutrients to the various tissue compartments, especially to the complex brains and other vital organs of mammals. In mammals, vagal innervation of pacemaker cells in the sinoatrial node appears to arise from two main sources, the

### X Preface

dorsal vagal nucleus in the dorsal brainstem and the nucleus ambiguous in the ventral brainstem. The vagal fibers from the dorsal vagal nucleus appear to be driven mainly by baroreceptor and other cardiovascular inputs. The signaling of these vagal fibers produces variability in the rate of sinoatrial node depolarization associated mainly with changes in blood pressure. The vagal fibers,which arise from the nucleus ambiguous, appear to be driven mainly by respiratory inputs and produces variability in the rate of the sinus node depolarization - known as heart rate variability or respiratory sinus arrhythmia.

The measurement and analysis of heart rate variability has been introduced trough *Advances in Electrocardiogram - Methods and Analysis*. In the present book, *Advances in Electrocardiograms - Clinical Applications*, the reader will be presented with clinical applications of heart rate variability, as well as a wide range of pathophysiological conditions associated with abnormal electrocardiograms. From electrolyte disturbances to toxic exposures; from hypertension and myocardial infarction to cardiomyopathies; from sleep apneas to heart failures. Being mindful that the roots of many electrocardiographic abnormalities develop during embryonic organogenesis of the heart, will lead to improved recognition, diagnosis and treatment of cardiac diseases.

> **Richard M. Millis, PhD**  Editor Dept. of Physiology & Biophysics The Howard University College of Medicine USA

X Preface

respiratory sinus arrhythmia.

dorsal vagal nucleus in the dorsal brainstem and the nucleus ambiguous in the ventral brainstem. The vagal fibers from the dorsal vagal nucleus appear to be driven mainly by baroreceptor and other cardiovascular inputs. The signaling of these vagal fibers produces variability in the rate of sinoatrial node depolarization associated mainly with changes in blood pressure. The vagal fibers,which arise from the nucleus ambiguous, appear to be driven mainly by respiratory inputs and produces variability in the rate of the sinus node depolarization - known as heart rate variability or

The measurement and analysis of heart rate variability has been introduced trough *Advances in Electrocardiogram - Methods and Analysis*. In the present book, *Advances in Electrocardiograms - Clinical Applications*, the reader will be presented with clinical applications of heart rate variability, as well as a wide range of pathophysiological conditions associated with abnormal electrocardiograms. From electrolyte disturbances to toxic exposures; from hypertension and myocardial infarction to cardiomyopathies; from sleep apneas to heart failures. Being mindful that the roots of many electrocardiographic abnormalities develop during embryonic organogenesis of the heart, will lead to improved recognition, diagnosis and treatment of cardiac diseases.

**Richard M. Millis, PhD** 

Dept. of Physiology & Biophysics

The Howard University College of Medicine

Editor

USA

**Part 1** 

**Cardiac Arrhythmias** 
