Long-Term Ambulatory Electrocardiography

195 Pages·1982·7.28 MB·English

by  P. V. L. Curry MD

LONG· TERM AMBULATORY ELECTROCARDIOGRAPHY
DEVELOPMENTS IN CARDIOVASCULAR MEDICINE
VOLUME 20
Other volumes in this series:
1. Lancee CT, ed: Echocardiology, 1979. ISBN 90-247-2209-8.
2. Baan I, Arntzenius AC, Yellin EL, eds: Cardiac dynamics. 1980. ISBN 90-247-2212-8.
3. Thalen HIT, Meere CC, eds: Fundamentals of cardiac pacing. 1979. ISBN 90-247-2245-4.
4. Kulbertus HE, Wellens HJJ, eds: Sudden death. 1980. ISBN 90-247-2290-X.
5. Dreifus LS, Brest AN, eds: Clinical applications of cardiovascular drugs. 1980.
ISBN 90-247-2295-0.
6. Spencer MP, Reid 1M, eds: Cerebrovascular evaluation with Doppler ultrasound. 1981.
ISBN 90-247-2384-1
7. Zipes DP, Bailey IC, Elharrar V, eds: The slow inward current and cardiac arrhythmias.
1980. ISBN 90-247-2380-9.
8. Kesteloot H, Ioossens IV, eds: Epidemiology of arterial blood pressure. 1980.
ISBN 90-247-2386-8.
9. Wackers FIT, ed: Thallium-201 and technetium-99m-pyrophosphate myocardial imaging
in the coronary care unit. 1980. ISBN 90-247-2396-5.
10. Maseri A, Marchesi C, Chierchia S, Trivella MG, eds: Coronary care units. 1980.
ISBN 90-247-2456-2.
11. Morganroth I, Moore EN, Dreifus LS, Michelson EL, eds: The evaluation of new anti-
arrhythmic drugs. 1981. ISBN 90-247-2474-0.
12. Alboni P: Intraventricular conduction disturbances. 1981. ISBN 90-247-2483-X.
13. Rijsterborgh H, ed: Echocardiology.1981. ISBN 90-247-2491-0.
14. Wagner GS, ed: Myocardial infarction: Measurement and intervention. 1982.
ISBN 90-247-2513-5.
15. Meltzer RS, Roelandt I, eds: Contrast echocardiography. 1982. ISBN 90-247-2531-3.
16. Amery A, Fagard R, eds: Hypertensive cardiovascular disease; pathophysiology and
treatment. 1982. ISBN 90-247-2534-8.
17. Bouman LN, Iongsma HI, eds: Cardiac rate and rhythm. 1982. ISBN 90-247-2626-3.
18. Morganroth I, Moore EM, eds: The evaluation of beta blocker and calcium antagonist
drugs. 1982. ISBN 90-247-2642-5.
19. Rosenbaum MB, ed: Frontiers of cardiac electrophysiology. 1982. ISBN 90-247-2663-8.
Series ISBN 90-247-2336-1
LONG-TERM
AMBULATORY
ELECTRO
CARDIOGRAPHY
edited by
J. ROELANDT, M.D. and P.G. HUGENHOLTZ, M.D.
Thoraxcentre. Erasmus University.
Academic Hospital Dijkzicht.
Rotterdam. The Netherlands.
11M
LII
1982
MARTINUS NIJHOFF PUBLISHERS
THE HAGUE/BOSTON/LONDON
Distributors:
for the United States and Canada
Kluwer Boston, Inc.
190 Old Derby Street
Hingham, MA 02043
USA
for all other countries
Kluwer Academic Publishers Group
Distribution Center
P.O. Box 322
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Library of Congress Cataloging in Publication Data
Main entry under title:
Long-term ambulatory electrocardiography.
(Developments in cardiovascular medicine
v. 20)
Proceedings of a symposium held Oct. 1981
at the Thorax centre of the Academic Hospital
Dijkzigt and the Erasmus University, Rotterdam
sponsored by the European Society of Cardiology.
Includes index.
1. Electrocardiography, ~mbulatory--Con­
gresses. 2. Heart--Diseases--Diagnosis--Con
gresses. I. Roelandt, Jos. II. Hugenholtz,
P. G. III. European Society of Cardiology.
IV. Series. [DNLM: 1. Electrocardiographv-
Methods. 2. Arrhythmia--Diagnosis.
3· Monitoring, ~ysiologic. Wl DE997VME v. 20/
WG 140 L849J
Rc683.5.A45L66 1982 616.1'207547 82-8042
ISBN-13:978-94-009-7572-9
ISBN -13: 978-94-009-7572-9 e-ISBN -13: 978-94-009-7570-5
DOl: 10.1007/978-94-009-7570-5
Copyright © 1982 by Martinus Nijhoff Publishers, The Hague.
S(dicol'er reprint qf the hard(,(JI'er 1st edition 1982
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system,
or transmitted in any form or by any means, mechanical, photocopying, recording, or otherwise,
without the prior written permission of the publisher,
Martinus Nijhoff Publishers, P.O. Box 566, 2501 CN The Hague, The Netherlands.
PREFACE
Recent technological developments have brought long-term ambulatory electro
cardiography to the front of clinical cardiology. Its application for solving clinical
problems potentially related to cardiac arrhythmias is rapidly increasing.
In the meantime, the method has found widespread use in the identification
of patients at risk for cardiac death as well as in the assessment of therapeutic
interventions.
It was the purpose of this symposium to bring together an international group
of authorities in order both to provide an overall view of the field and to discuss
critically the value of clinical, epidemiological and research applications of long
term ambulatory electrocardiography in the light of new concepts and recent
advances.
The first section of this volume discusses the methodology and the performance
criteria of the equipment and analysis systems.
In the second section, the potentials and problems encountered in the use of
long-term ambulatory electrocardiography for solving clinical questions and for
predicting the occurrence of clinically important arrhythmias are extensively
dealt with. New applications such as continuous ST segment monitoring, blood
pressure measurement and other physiologic parameters are also included.
Prevalence variability and prognostic aspects of ventricular arrhythmias, both
in normals and in patients with cardiac disease, are the subject of section 3. The
last section provides a critical review of the use of the method for the evaluation
of therapeutic interventions with drugs. The editors feel that this volume represents
the 'state of the art' in this newly important area of clinical cardiology.
J. Roelandt
P.G. Hugenholtz
ACKNOWLEDGEMENTS
The contents of this volume represent the accumulated scientific information that
emerged from the symposium on Holter Electrocardiography held in October
1981 at the Thoraxcentre of the Academic Hospital Dijkzigt and the Erasmus
University in Rotterdam.
Each of the speakers kindly consented to supply a manuscript of their presenta
tion and we would like to express our gratitude to them.
The symposium was sponsored by the European Society of Cardiology and
financial support was provided by the Cardiolab Foundation.
The organization required a great deal of work and of secretarial assistance.
Mrs Marjolijn Sneep-de Korver handled this with great dedication and efficiency,
for which we are most grateful. We also much appreciate Mr B.F. Commandeur's
professional help with the production of this volume.
J. Roelandt
January 1982 P.G. Hugenholtz
vii
CONTENTS
v
Preface.
Acknowledgements. VI
SECTION 1. METHODOLOGY AND PERFORMANCE CRITERIA OF THE
RECORDING AND ANALYSIS SYSTEMS
1. Holter Monitoring - How should it be performed?
P.V.L. Curry,
2. Equipment Specifications and Performance Criteria: Clinical Evaluation. 6
C. Zeelenberg, K.L. Ripley, R. Okkerse.
3. Clinical Importance of Computer Assisted Longterm ECG Analysis.
H.S. Weber, G. Joskowicz, D. Glogar, K.K. Steinbach, F. Kaindl.
SECTION 2. CLINICAL USEFULNESS OF LONG-TERM AMBULATORY
RECORDINGS OF THE ELECTROCARDIOGRAM, BLOOD PRESSURE
AND OTHER PHYSIOLOGICAL PARAMETERS
4. Holter Monitoring in the evaluation of Palpitations, Dizziness and Syn-
c~. ~
D. Burckhardt, B.E. Luetold, M.V. Jost, A. Hoffman.
s.
Clinical Relevance of Supraventricular Arrhythmias detected by Holter
Electrocardiography. 40
J.F. Leclercq, R. Slama.
6. Heart Rate Trend Analysis: Patterns and Clinical Significance. 51
P. Coume!.
7. Techniques for Recording and the Clinical Relevance of Ventricular
Arrhythmias in Ambulatory Patients. 62
R.A. Winkle, I. Rodriquez.
viii
8. Comparison between Repetitive Ventricular Extrasystoles Induced by
programmed Electrical Stimulation and their Spontaneous Occurrence
on Ambulatory Electrocardiography. 70
K.P. Bethge, H. Klein.
9. The role of Ambulatory Electrocardiographic Monitoring, Exercise
Stress Testing and Electrophysiologic Studies in the Management of
Patients with Malignant Ventricular Arrhythmia. 79
T.B. Graboys.
10. Continuous ST-Segment Monitoring: Indications and limitations. 88
M.L. Simoons.
11. Continuous Blood Pressure Measurement. 98
P. Sleight.
12. Application of Holter Electrocardiography to Physiological Measure-
ments in Man. 105
K. Bachmann.
SECTION 3. EPIDEMIOLOGIC AND PROGNOSTIC ASPECTS OF VEN
TRICULAR ARRHYTHMIAS
13. Prevalence of Cardiac Arrhythmias in the Normal Active Population. 123
V. Manger Cats, D. Durrer.
14. The Spontaneous Variability of Ventricular Arrhythmias. 133
SJ. Connolly, R.A. Winkle.
15. Classification of Cardiac Arrhythmias and Conduction Defects for Risk
Assessment. 146
H.E. Kulbertus.
16. Prognostic Aspects of Ventricular Arrhythmias in Patients with Coro-
nary Artery Disease. 155
A.J. Moss.
SECTION 4. VALUE OF LONG-TERM AMBULATORY ELECTRO
CARDIOGRAPHY IN THE EVALUATION OF THERAPEUTIC INTER
VENTIONS FOR THE PREVENTION OF PREMATURE CARDIAC
DEATH
17. Design of Secondary Preventive Trials with Anti-Arrhythmic Agents:
The Right Question with the wrong Answer. 160
J. Lubsen.
18. Testing the Efficacy of Antiarrhythmic Therapy. 165
R.J. Prineas.
19. Translating Results of Clinical Trials into Clinical Relevance. 176
D.G. Julian.
Index of subjects 000
ix
CONTRIBUTORS
Bachman, K., Herzzentrum der Universitat, Ostl. Stadtmanerstrasse 29, 8520
Erlangen, BRD.
Bethge, K.P., Medizinische Hochschule Hannover, Abteilung fUr Innere Medizin,
3 Hannover-Kleeveld, BRD.
Burckhardt, D., Division of Cardiology, University Hospital, CH-4031, Basel,
Switzerland.
Connolly, S.J., Cardiological Division, Stanford University, Stanford, CA 94305,
USA.
Coumel, P., Department de Cardiologie, H6pital l.ariboisiere, 2, Rue Ambroise
Pare, 75010 Paris, France.
Curry, A., Guy's Hospital, Department of Cardiology, St. Thomas Street, London
SE1 9RT, United Kingdom.
Durrer, D., Department of Cardiology, Wilhelmina Gasthuis, Ie Helmerstraat 104,
1054 EG Amsterdam, The Netherlands.
Glogar, D., Kardiologische Universitatsklinik, Garnisongasse 13, A-I097 Wien,
Austria.
Graboys, T B. Harvard University, School of Public Health, 665 Huntington
Avenue, Boston MA 02115, USA.
Hoffman, A., Division of Cardiology, University Hospital, CH-4031 Basel, Switzer
land.
Joskowicz, G., Kardiologische Universitatsklinik, Garnisongasse 13, A-I 097, Wien,
Austria.
Jost, M.Y., Division of Cardiology, University Hospital, CH-4031, Basel, Switzer
land.
Julian, D.C., University of New Castle, Freeman Hospital, New Castle-Upon-Tyne,
NE7 7DN, United Kingdom.
Kaindl, F., Kardiologische Universitatsklinik, Garnisongasse 13, A-I097, Wien,
Austria.
Klein, H., Medizinische Hochschule Hannover, Abteilung fiir Innere Medizin, 3
Hannover,3 Hannover-Kleeveld, BRD.
Kulbertus, H., Universite de liege, H6pital de Baviere, 66, Boulevard de la Con-
x
stitution,4000 Uege, Belgium.
Leclercq, J.F., H6pital Lariboisiere, 2 Rue Ambroise Pare, 75475 Paris, France.
Lubsen, J., Thoraxcenter, Erasmus University, P.O. Box 1738,3000 DR Rotter
dam. The Netherlands.
Luetold, B.E., Division of Cardiology, University Hospital, CH-4031, Basel, Swit
zerland.
Manger Cats, V., Department of Cardiology, Wilhelmina Gasthuis, Ie Helmerstraat
104, 1054 EG Amsterdam, The Netherlands.
Moss, A., 873 Elmwood Avenue, Rochester, NY 14620 USA.
Okkerse, R., Thoraxcenter, Erasmus University, P.O.Box 1738,3000 DR Rotter
dam. The Netherlands.
Prineas, R., University of Minnesota, Laboratory of Physiological Hygiene, School
of Public Health, Stadium Gate 27, Minneapolis MI 55455, USA.
Ripley, K.L., Thoraxcenter, Erasmus University, P.O.Box 1738,3000 DR Rotter
dam, The Netherlands.
Rodriquez, I., Cardiological Division, Stanford University, Stanford CA 94305,
USA.
Simoons, M.L., Thoraxcenter, Erasmus University, P.O. Box 1738, 3000 DR
Rotterdam, The Netherlands.
Slama, R., Hopital Lariboisiere, 2 Rue Ambroise Pare, 75475 Paris, France.
Sleight, P., Oxford University, 32 Crown Road, Wheatley, Oxford, United King
dom.
Steinbach, K.K., Kardiologische Universitiitsklinik, Garnisongasse 13, A-I 097 Wien,
Austria.
Weber, H., Kardiologische Universitiitsklinik, Garnisongasse 13, A-I097 Wien,
Austria.
Winkle, R.A., Cardiological Division, Stanford University, Stanford CA 94305,
USA.
Zeelenberg, C., Thoraxcenter, Erasmus University, P.O. Box 1738, 3000 DR
Rotterdam, The Netherlands.