Atrial flutter - atrial fibrillation: Is a distinction clinically necessary?

In most cases, the distinction between atrial flutter and atrial fibrillation can readily be made from their ECG characteristics. Some cases, however,show characteristics of both. Because of the similarity in etiology, hemodynamic response, and current respobnse to pharmacological treatment, differentiation between the two arrhythmias may not be necessary

A simple numerical coding system for clinical electrocardiography

A simple numerical coding system for clinical electrocardiography has been developed. This system enables the storage in coded form of the ECG analysis. The code stored on a digital magnetic tape can be used for a computer print-out of the analysis, while the information can be retrieved at any time if needed. Experience gained in the coding of 35,000 ECGs has shown that the system meets the requirements in a large hospital, and can easily be combined with computer analysis of ECGs

An automated ECG system in a large hospital: coding, storage and retrieval of tracings

This paper describes an automated ECG-system as it is used in the 1000-bed University Hospital Utrecht, The Netherlands. The system involves a "hybride" approach, combining computer analysis of the ECG by means of the Pipberger program with the reading by a cardiologist via a specially developed coding system. Up until now (since January 1, 1972) 35,000 ECGs have been handled systematically at a rate of approximately 100 ECGs per working day. All the ECGs, together with the ECG-diagnoses and other relevant data of the patient are stored and can be retrieved whenever wanted. The system enables comparison of computer analysis and cardiologist's reading of the ECG. The boundary between reliable computer analysis and the necessity of human reading and verification lies with the normal ECGs. This apparently meagre result of the computer ECG-analysis for hospital use is, however, a great achievement for its use in epidemiological studies

Micturition syncope : clinical note

The case history is presented of a 37-year-old pilot with micturition syncope. Three spontaneous nocturnal attacks were observed clinically and with EEG and ECG recording. These recordings started at the moment the patient went to bed. In this way the EEG and ECG on awaking during the night, rising from the bed and voiding while in the upright position were studied. Since fainting always occured some 30 sec after the patient had finished voiding and since no obstruction in the urogenital tract and bladder was found, and the patient denied straining on micturition, a Valsalva effect cannot be regarded as an important aetiological factor. The syndrome is considered to be a vaso-vagal or vasodepressor reaction upon assuming the upright position under special circumstances, in which a low heart rate combined with lowered peripheral vascular resistance is presumably the most important factor. From the EEG and ECG records it is clear that the attacks are not of epileptic origin and that they cannot be explained by slowing of the heart rate alone. EEG recording during an attack is considered to be essential for differentiating between this syndrome and epilepsy because they may resemble each other clinically and because the resting EEG nearly always shows a normal pattern. The syndrome was not considered as a contraindication for licensing the pilot

Een geautomatiseerd ECG-systeem

De automatische verwerking van elektrocardiogrammen, respectievelijk de automatisering van de elektrocardiografie begint - ondanks veel aanvankelijke weerstanden - op een aantal plaatsen in ons land vorm te krijgen. Hoewel een nationale aanpak onzes inziens nog steeds de voorkeur zou verdienen (MEIJLER 1970), lijkt het van belang een lokaal systeem te beschrijven dat wellicht als voorbeeld kan dienen van de automatisering van de elektrocardiografie in een, naar de maatstaven van ons land, groot ziekenhuis. Het hier te beschrijven systeem kan eventueel model staan voor een groter systeem in regionaal of nationa al verband; het bevat daarvoor alle benodigde elementen. Het doel van dit artikel is aan te tonen dat een groot geautomatiseerd ECG-systeem metterdaad mogelijk is. Voorts lijkt het gewenst dat in bredere kringen bekend wordt hoever de automatisering van de elektrocardiografie is voortgeschreden en over welke mogelijkheden we thans reeds beschikken

Het aangeboren lange-QT-tijdsyndroom

The long QT syndrome (LQTS) combines a prolonged QT interval with an enhanced risk of polymorphous ventricular arrhythmias that may lead to syncope and sudden cardiac death. It may be congenital or acquired (the latter sometimes caused by drugs). Congenital LQTS is a rare disease, usually discovered during the clinical evaluation of understood syncopes or at cardiological examination after an unexpected sudden cardiac death of a close relative. The syncope frequently occurs during physical exercise, fear or sudden loud noises. In patients with symptomatic LQTS, the mortality 10 years after the first syncope amounts to approximately 50%. A prolonged QT interval indicates abnormal repolarization or deceleration of the depolarization. An increase of the sympathetic tone, e.g. during physical exercise and emotions, causes prolongation of the QT interval. Congenital LQTS has been associated with genetic mutations, for instance on chromosomes 3 and 7. Treatment consists af administration of beta-blockers, sympathectomy and, if necessary, implantation of an automatic cardioverter/defibrillato

Integrated processing of ECG's in a hospital information system

The ECG handling in the University Hospital of Utrecht is composed by a system consisting of acquisition and storage of ECG signals, computer analysis, data management, and storage of readings in a patient data base. The last two modules are part of a Hospital Information System (HIS). The modular structure of the system, enhanced by a condensed report coding system enables a close integration of computer analysis, cardiological expertise and administration. The experience with this system and the advantages of the integration in a HlS are discussed

Role of atrial fibrillation and atrioventricular conduction (including Wolff-Parkinson-White Syndrome) in sudden death

A short refractory period of the accessory pathway is considered a major threat for sudden death in patients with Wolff-Parkinson-White syndrome and atrial fibrillation. RR interval and QRS signal analysis together with signal analysis of a bipolar high right atrial electrogram were obtained in six patients with Wolff-Parkinson-White syndrome and either induced or spontaneous atrial fibrillation. A record of a sufficiently long episode of atrioventricular (AV) conduction by way of the bypass tract that could be used for satisfactory RR interval sequence and QRS analysis was obtained from only one patient. The results were compared with those of a representative patient with atrial fibrillation and normal AV nodal-His conduction. In a patient with Wolff-Parkinson-White syndrome, atrial fibrillation and AV conduction by way of the bypass tract may exhibit high ventricular rates (median RR intervals of about 300 ms) and long/short RR interval ratios of just over 1 (RR intervals not exceeding 400 ms). The right atrial electrogram showed a noiselike excitation pattern. This study suggests that rather than a short refractory period of the bypass tract, it is lack of concealed conduction, responsible for the presence of long RR intervals, that allows the ventricles to reach very high ventricular rates and at times to fibrillate. The normal AV nodal-His system seems to protect the heart against high ventricular rates and ventricular fibrillation during atrial fibrillation by its relatively long refractory period and capacity to in duce long RR intervals by means of concealed conduction