By Hein J. J. Wellens
The interaction among the cautious research of scientific electrocardiograms and effects from animal experiments have some time past 60 years led to provo cative and brill ant suggestions at the mechanisms of cardiac arrhythmias in guy. some of the animal experiments even if have been performed on open-chested canine with lower cardiac nerves and lower than the effect of pharmaca. it's uncertain, consequently even if those effects could be transferred with out reser vation to the human scenario. The creation of electric stimulation of the guts in medical cardiology has opened new how you can research a few points of cardiac arrhythmias without delay within the unaesthesized sufferer. This research reviews observations on sufferers who have been admitted to the college division of Cardiology, Wilhelmina Gasthuis, Amsterdam, for the overview and therapy of tachycardias. Electrically brought on untimely beats have been utilized in an attempt to explain the foundation and mechanism of those tachycardias. the 1st bankruptcy is on class and analysis of tachy cardias with distinctive emphasis on our present wisdom of the differential prognosis among supraventricular tachycardias with aberrant conduction and ventricular tachycardias. this is often through theoretical concerns on tachycardias in particular with regards to the equipment utilized in this examine. After an overview of those equipment the result of our reviews in sufferers with atrial flutter, A-V junc tional tachycardias and tachycardias concerning the pre-excitation syndrome are stated. A dialogue at the price of electric stimulation for the remedy of tachycardias is by way of a precis of our results.
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Additional info for Electrical Stimulation of the Heart in the Study and Treatment of Tachycardias
The same phenomena were observed in patient F (see fig. 31). In patient G a ventricular premature beat (V l ) given after an interval of 360 msec or less was followed by a less than compensatory interventricular interval (fig. 32). On shortening the premature beat interval (V - V l) the distance between the induced ventricular beat (V 1) and the retrograde activation of the atrium (Al) increased. This indicates that retrograde conduction through the A-V node became increasingly hampered (see fig.
On shortening the premature beat interval it becomes clear that the pause following the premature atrial activation is always fully compensatory. 31 ATRIAL FLUTTER 2. The influence of one electrically induced atrial premature beat on the atrial flutter Stimuli were applied high and low on the free lateral wall of the right atrium. The first site of stimulation was chosen to stimulate close to the origin of the reported internodal tracts (James (57) and Meredith and Titus (94)). When an extra stimulus was applied to the atrial wall following every 8th flutter complex, and the interval between the last flutter complex and the extra stimulus progressively shortened up to the refractory period of the right atrium, the interval to the next flutter wave differed in length depending upon the site of atrial stimulation.
Spurious pulses, due to disturbances in the mains or the ground including on and off switching of the apparatus, are prevented. All stimuli as well as the electrical activity of the heart are displayed on the screen of an oscilloscope. During this study the duration of the stimuli was kept at 2 msec. Current strength was less than two times the diastolic threshold current. (Van Dam et al. (24), Van Dam (25)). A schematic representation of the way synchronization and stimulation were done (in this instance during the study of atrial flutter) is given in figure 6.