[Non-invasive diagnosis of tachycardial heart arrhythmias]. / Nichtinvasive Diagnostik tachykarder Herzrhythmusstörungen.

The exact recognition of arrhythmias (AR) is the basis for decision making weather to treat AR or not. During the past the field of non-invasive, diagnostic tools approached from a simple 12-lead-routine ECG to higher sophisticated methods. This paper deals with the advantages and disadvantages of those non-invasive methods for AR-detection. Exercise Stress Tests (ET) are of value for the detection of "exercise induced" ventricular arrhythmias and tachycardias frequently related to ischaemia or cardiac congestion. ECG-Telemetry recognizes AR during the postinfarction-period during moderate exercise. The transmission of the ECG via the public telephone net (ECG-Telephone-Telemetry) is used in symptomatic patients possibly related to AR. With the ECG-TTM AR can be excluded in one third and in another third confirmed as cause for the symptoms. The Long-term ECG recording (Holter Monitoring) is today a frequently used method in the daily routine to detect AR and to control therapeutic effects. To avoid misinterpretations of the analysis-results we should be familiar with the system used and we have to look with criticism on the results presented by a machine. A new method, the registration of Late Potentials using the averaging technique of a high amplified ECG seems to be promising for risk-stratification: Patients with such Late-Potentials develop frequently ventricular tachycardia or die suddenly. Prior the use of invasive diagnostic methods or therapeutic interventions it is possible to recognize AR with the above mentioned complementary methods successfully.

[Value of ECG-telephone transmission in determining symptomatic heart-rhythm disorders]. / Wertigkeit der EKG-Telefon-Telemetrie in der Erfassung symptomatischer Herzrhythmus-Störungen.

The ECG-telephone-transmission (TTM) was used to record an ECG-strip during a typical symptomatic period in patients complaining of symptoms possibly caused by arrhythmias (palpitations, dizziness, paroxysm tachycardia, pulse irregularities; angina and dyspnea only if other reasons could be excluded). Patients complaining of syncope only were not admitted, because of the inability to make a telephone call successfully during such a symptomatic period. The ECG was transmitted to the CCU using a frequency modulation technique. In 60% of 196 patients an ECG-TTM could be achieved during a typical symptomatic period, whereas arrhythmias as cause for the symptoms could be excluded in 51 patients (26%). The remaining 66 patients (34%) demonstrated various arrhythmias ranging from simple SVPB and PVC to total AV-block and sustained VT. TTM, an easy-to-perform and cost-effective method allowed a successful ECG registration during a symptomatic period in almost two-thirds of symptomatic patients. In these patients arrhythmias could be verified or excluded as cause of the symptoms.

[Vagus block in the therapy of bradycardial arrhythmias--the role of autonomic balance]. / Vagusblockade in der Therapie bradykarder Herzrhythmusstörungen--Rolle der vegetativen Balance.

UNLABELLED: A medicamentous therapy of bradycardiac disturbances of heart rhythm can be performed on the one hand by stimulation of the sympathetic nerve, on the other hand by blockade of the parasympathetic system. An ester of the tropic acid, Ipratropiumbromide (IP), shall be used for answering the question to what extent the heart rate may be increased in such arrhythmias. In 10 patients (4 females and 6 males, m 60 +/- 9 years old) with asymptomatic bradycardiac arrhythmias (heart rate less than 60 per min in the routine ECG; 3 patients AV-block III, 1 patient AV-block II II, 6 patients sinus bradycardia) at first a 24-hour long-term ECG was recorded under ambulatory conditions, after this 1 mg IP was administered intravenously under continuous long-term ECG. After 4 days 10 mg IP orally thrice a day, in 3 patients also after 15 mg IP t.i.d. a repeated long-term ECG was performed. These were evaluated using the computer-assisted "multipass scanning" system. RESULTS: 1 hour after 1 mg IP intravenously the m heart rate significantly increased about 17-87% (m 55%) in all patients (p less than 0.001). Proportionally to the increase of the heart rate it lasted 7-14 hrs. till the initial heart rate was reached again. 1-4 hours after intravenous injection in 2 patients sinus tachycardias developed as an expression of an increased sympathicotonia. 10 mg IP led to an increase of the heart rate of m 8% of the patients, during the day m 9%, during the night 4%.(ABSTRACT TRUNCATED AT 250 WORDS)

[Thrombocyte migration test--method, value and reproducibility]. / Thrombozytenmigrationstest--Methodik, Wertigkeit und Reproduzierbarkeit.

A method for platelet migration testing is presented. The results are comparable using sodium citrate and acid citrate dextrose as anticoagulants, whereas other anticoagulants lead to lower absolute migration. The day-to-day variability of the method is higher than the intra-day variability. The variability between the patients is higher than that between measurements carried out on the same patient. There is no correlation to ADP-induced platelet aggregation.

[Emission-computed tomography of the myocardium with the 7-pinhole collimator]. / Emissions-Computertomographie des Myokards mit dem 7-Pinhole-Kollimator.

89 patients (78 with coronary artery disease, 11 normals) were studied comparatively with T1-201 planar myocardial scintigraphy and 7-pinhole emission tomography with a mobile gamma-camera. In 46 patients stress studies were performed, the other studies were performed as resting protocols. In 13 patients a correlation of scintigraphically determined infarct size calculated from the T1-201 tomograms with CK and CK-MB values (maximum values) in the acute infarction period was performed. 17 patients having undergone intracoronary streptolysis were studied to investigate the effect of this intervention. In patients without previous myocardial infarction (n = 35) sensitivity of 7-pinhole tomography was significantly superior over planar reading of images (83% for qualitative evaluation, 91% for quantitative analysis). In patients with previous myocardial infarction (n = 26) comparative sensitivities were not significantly different, although slightly higher, nevertheless the fraction of questionable findings was reduced from 9 to 4%, furthermore in 31% an additional information concerning size or localization could be obtained from the tomograms. Predictive diagnostic accuracy was highest for quantitative 7-pinhole tomography (91%) but not significantly different from qualitative tomography but higher than for planar imaging. Specificities of all methods were comparable. In patients during the acute phase of myocardial infarction a significant correlation (r = 0.76 for CK, r = 0.78 for CK-MB, p less than 0.01) was obtained with enzymatic markers of infarct size. In the group after intracoronary streptolysis 7-pinhole tomography was able to demonstrate a quantitative reduction of thallium infarct size in patients after successful lysis (23.5% vs 48.7%, p less than 0.01) although absolute quantitation is not possible with thallium-201 due to inherent biological limitations. Emission tomography using 7-pinhole collimation leads to an improvement of diagnostic accuracy in all patients with reversible ischemia and helps for better delineation of size and localization of infarct areas and could help in the assessment of interventional effects, as after intracoronary streptolysis.

[A new method for quantification of 2-dimensional echocardiographic images of the left ventricle (author's transl)]. / Ein neues Verfahren zur Messung 2-dimensionaler sonographischer Schnittbilder des linken Ventrikels.

A computer-supported system was designed for processing of 2-dimensional echocardiographic images of the left ventricle. The purpose of the method is to improve quantitative analysis of regional contraction patterns of the ventricle, using a 3-dimensional reconstruction technique. The definition of the spatial position of the transducer and a computer assisted outlining of the ventricle are the main features of the system. The usefulness of this method was demonstrated in a preliminary study.

[Off-line data base system for out-patients (author's transl)]. / Aufbau und Anwendung eines Datenbanksystems zur Erfassung ambulanter Patienten.

About 7000 out-patients of the Kardiologische Universitätsklinik in Vienna have been documented in an off-line data base system. The documentation includes the diagnosis (cardiac diagnoses in WHO-code), date of special events (operations, interventions and complications) and the clinical follow-up. The data entry is done by interactive defined data definition tables (similar to codasyl). A powerful query language was built and the sorted data can be used for patient listing, statistical analysis or as in-put for a letter system. With this data base system it is possible to support the daily work, i.e. to write automatically letters to patients, who did not come to their appointment. For scientific means the data base system is able to answer in a simple and fast way specific questions, i.e. search for patients with different diagnoses and specific events at certain times.

[Computer assisted long-term ECG analysis: method and clinical importance (author's transl)]. / Methodik und klinische Bedeutung der rechnergestautzten Langzeit-EKG-Analyse.

The basic principle of computer assisted analysis of Holter recordings is to store the whole ECG after data reduction and AD conversion in digitized form on random access medium like magnetic disks. In "Multipass Scanning" the linear segmentation techniques leads to highly reproducible ECG-data, which were analysed during multiple passes under continuous operator control. The field of clinical applications of such a highly sophisticated method reaches from supraventricular over ventricular to symptomatic arrhythmias. In combination with ECG-telefon-telemetry computer assisted LT-ECG analysis could be used in more than 75% of the patients successfully. The clinical expectations during routine could be fulfilled in more than 75%. Commonly a detailed numerical or graphical description of clinical relevant arrhythmias were necessary in the demand of the routine. So computer assisted LT-ECG analysis is not only a tool for research, but also valuable in the clinical routine.

[Computer-assisted long-term ECG analysis in patients with artificial trial pacemaker (AAI) (author's transl)]. / Rechnerunterstützte Langzeit-Ekg-Analyse bei Patienten mit Vorhofschrittmachern.

Control of AAI-function is limited. To investigate the efficacy of AAI-stimulation, a computer-assisted analysis system for long-term ECG records was developed using "Multipass-Scanning I". 12 patients (5 females, 7 males, 33--78 years old with AAI) underwent Holter-monitoring for 24 hours continuously. THe ECGs of 5 among the collective with heart rate programmable AAI were recorded three times each with different AAI stimulation rates (50--80 b.p.m.). The number of AAI-induced heart beats in relation to the total number of QRS-complexes (AAI-QRS%) was 43 +/- 37% mean. AAI-QRS% during day showed a significantly lower distribution (35 +/- 38%, p less than 0.01) than during night (58 +/- 40%, p less than 0.001). Using an AAI-stimulation frequency of 50 b.p.m., only 9% of the heart beats were AAI-induced during day. Whereas AAI-QRS% increased to 72% during night in patients with AAI-stimulation frequency of 70 b.p.m. The interval between the PM-spike (S) and the following answer of the heart, i.e. SR-interval, demonstrated also a circadian behaviour: SR max occurred between 10 p.m. and 2 a.m. It was significantly prolonged to the SR min. (9--31%, m 20%, p less than 0.0001), which occurred between 9 a.m. and 4 p.m. So the presented computer-assisted long-term ECG analysis system for AAI-pacemakers is able to evaluate the efficacy of AAI with regard to different AAI-stimulation rates. The quantity of AAI-induced heart beats is dependent on patient's heart rate, its circadian behaviour and the stimulation rate of the AAI. The SR-interval also demonstrated a significantly circadian pattern, which can be related to the vagus-influenced PQ- and also AH-interval.

[Quantitative evaluation of an antiarrhythmic therapy (disopyramide) in patients with frequent premature ventricular contractions (PVC) using a computer-assisted long-term ECG analysis system (author's transl)]. / Rechnerunterstützte Langzeit-Ekg-Analyse in der quantitativen Beurteilung einer antiarrhythmischen Therapie ventrikulärer Extrasystolen mit Disopyramid.

15 patients (pts.) - 12 males, 3 females - with frequent PVC (greater than 3%/16 hr during a qualifying period = LP) of different causes underwent after one-day placebo application (PL) drug treatment (disopyramide: loading dose 600 mg, 300 mg t.i.d.) over two days (D1, D2). The ambulatory continuously recorded long-term ECG was analysed using "Multipass-Scanning", a computer-supported analysis system for quantification of therapeutic success. The mean PVC rate of 17% prior treatment could be diminished in 87% of the pts. significantly. 5 pts. (group I) demonstrated a maximal PVC-reduction rate of more than 90 rel %. Among them in 2 pts. the PVC-rate did not exceed the 1%-level during D1 and D2 demonstrating an optimal therapeutic success. The max. PVC-reduction rate ranged between 80 and 90 rel % in 3 pts. (group II) and between 38 and 78 rel % in 5 pts. (group III). 2 pts. did not respond on DP. The mean DP-plasma level was higher in group-III pts. than in group-I or -II pts. in spite of a less therapeutic success. 7 pts. demonstrated a circadian behaviour of PVCs. Therefore the circadian variability increased. Also lower PVC rates under DP (D1, D2) led to an increase of spontaneous variability of PVCs. The maximal PVC depressant effect of DP appeared while the heart rate was 70 b.p.m. or higher. In conclusion, 87% of the pts. demonstrated a drug effect, but an effective antiarrhythmic therapy occurred only in 2 pts. (13%). A decrease of the frequency of rhythm disturbances led to a decrease of arrhythmia's variability and requires a prolongation of the ECG-recording time to eliminate the variabilities of arrhythmia occurred (spontaneous, circadian) and to avoid a mimicked therapeutic success.

[Documentation of arrhythmias - the value of long-term ECG monitoring]. / Dokumentation von Rhythmusstörungen - der Stellwert der Langzeit-EKG-Uberwachung.

Computer-supported long-term ECG-analysis, must be considered as complementary to other methods of documentation concerning arrhythmias. With the introduction of computers in the last several years, exact quantification and qualification of arrhythmias, over long monitoring periods, has become possible. With this method diverse forms of documentation and data presentation enhance its value of information and increase plausibility. Major indications for long-term ECG-monitoring of ambulatory patients are detection of occult arrhythmias, evaluation of subjective symptoms such as dizziness or syncope, recognition of pacemaker dysfunctions, selection of patients with coronary heart disease at high risk and evaluation as well as control of the efficacy of antiarrhythmic therapy.

Assessment of regional wall motion in coronary artery disease using radionuclide methods.

72 patients with CAD, 10 patients with congestive cardiomyopathies and 10 normal subjects were evaluated by radionuclide angiography. Comparison with contrast angiography showed good results for LVEF (r = 0.83). Regional asynergies observed in the radionuclide angiography correlated well with defects in thallium scintigrams. Extent of abnormal wall motion was measured and compared with normals, appreciating the deviation from the normal mean radial shortening. Good correlation could be demonstrated with radionuclide ventriculography. In 80% of congestive cardiomyopathies the right ventricle wall became visible in the thallium scintigram.

[Circadian variations in the frequency of arrhythmia and quantitative analysis of rhythm disturbances]. / Zirkadiane Schwankungen der Arrhythmiehäufigkeit und quantitative Analyse von Rhythmusstörungen.

In 29 patients with long term ECG monitoring the circadian rhythm of extrasystoles was investigated. A decrease of maximal frequency of extrasystoles was calculated for each hour and an increase of the minima during night was detected. In 77% of the patients also for 6 hour-segments a circadian rhythm could be calculated. The effect of the antiarrhythmic treatment on the frequency of extrasystoles was different depending on the frequency of the sinus rhythm.

A global display of the heart vector (spherocardiogram). Applicability of vector-and polarcardiographic infarct criteria.

The spatial loop of the heart vector can be projected on the Aitoff projection of the globe. The complete information that is contained in the orthogonal leads in displayed on a single graph when the vector magnitudes are indicated by the diameter of circles drawn around the vector projection in short time intervals (spherocardiogram). Diagnostic vector- and polarcardiographic criteria were applied to the spherocardiograms of 68 survivors of inferior myocardial infarction and 30 healthy men. Sensitivity increased from 65% (standard 12-lead ECG) to 87% (VCG criteria) (P less than 0.001) to 94% (VCG and PCG criteria combined), with no false-positive diagnoses. The spherocardiogram can be obtained by use of an "intelligent plotter." In contrast to the vectorcardiogram (VCG) and the polarcardiogram (PCG), it permits the direct visual study of the spatial direction and the spatial magnitude of the heart vector and of their sequential changes during the heart cycle.