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Summary The computer-system for the on-line-analysis of hemodynamic data developed in Aachen enables the clinical user to perform the immediate on-line analysis of ECG, pressure-curves and thermo- or dye-dilution-curves in a dialog mode. The procedure of pressure analysis as well as the calculations by the computer for the individual haemodynamic parameters are described. The comparison of the medicalmanual evaluation of the pressure curves on paper-registration and the computer results of the same measurement shows a very good correlation for wave-recognitions and wave-measurements for this system, integrated in the daily routine since 24 months. As well in the application of various fluid-filled catheters used in praxis as in tip-manometers it could be proved for the pressure-analysis in the different positions of the heart, that the computer-system produces reliable evaluations for all catheter materials used. The flexible conception of the computer program with its fast adaption to new problems allows its use not only in the clinical routine, but also and especially in the handling of scientific questions in the frame-work of haemodynamic analysis.

Summary A patient with a persistent form of atrial standstill is presented. The rarity of this arrhythmia is emphasized and the possible mechanisms involved and the diagnostic criteria are discussed.

Abstract: A hydromechanical model is developed for the simulation of the arterial systemic circulation. The geometry and elastic properties of arteries, the pulse-rate and stroke volume of the left ventricle, the design of peripheral resistances and the viscosity of the model fluid are approximated to physiological conditions. The parameters, pulse rate, stroke volume, pulse volume, elasticity of arteries, as well as peripheral resistances, are independent variables.

Abstract: Our online program was developed to identify premature atrial and ventricular contractions and missed beats. Special care is taken with the recognition of artefacts. 14 patients with a high rate of arrhythmias were studied and 108 000 beats analysed independently by cardiologists and correlated with the computer analysis. Of a total of 7458 premature ventricular contractions, 411 events were detected false positives or negatives. This is an error of 5%. Out of the 826 premature atrial contractions 140 mistakes were found (17%). In a group 1772 missed beats (av-block etc.) 159 were improperly identified (9%). Of 1410 ventricular ectopics without prematurity there were 164 incorrect results (12%). The vast majority of muscle potentials and artefacts was properly classified and detected (error 11–15%). The main reason for the errors is the bad signal-to-noise ratio experienced from time to time. With the help of a digital computer a reliable analysis of the most important arrhythmias in intensive care patients has been achieved. A main part of the program should be concerned with artefact detection.

Summary A hydromechanical model for the simulation of the arterial systemic circulation is developed. Geometry and elastic properties of arteries, frequency-dependent volume pulses of the left ventricle, design of peripheral resistances and the viscosity of the model fluid are approached to physiological conditions.

Summary The vulnerability of the right atrium to single electrical stimuli was investigated in 100 nonselected patients. According to the response pattern to extrasystolic stimulation of the right atrium during the relative refractory period, the patients could be divided in 3 groups:Group A:no signs of vulnerability.Group B:1 to 5 additional atrial extrasystoles after the premature atrial stimulus.Group C:runs of atrial flutter or fibrillation for at least 8 s.

Summary Using the extrastimulus method in 100 patients, premature impulses were applied during the relative refractory period of the right atrium. Depending on the atrial response to these impulses we divided our patients in the following 3 groups: Group A: no repetitive firing (61 patients); group B: 1 to 5 additional atrial extrasystoles with a total duration of maximum 1.5 s (27 patients); group C: runs of atrial flutter or fibrilation for at least 8 s (12 patients). The statistical analysis of the following parameters: age, PA interval, absolute and corrected sinus node recovery time did not show any significant difference between the 3 groups. These results suggest that the investigated parameters are of no great importance in the genesis of the atrial vulnerability.

Zusammenfassung 70 Patienten wurden mittels vorzeitiger Vorhofstimulation bei 3 verschiedenen Frequenzen: 80, 100 und 120/min untersucht. Bei jeder dieser Frequenzen wurden die effektive, die relative, die gesamte und die funktionelle Refraktärzeit des rechten Vorhofes bestimmt. Bei 30 Patienten traten während der vorzeitigen Stimulation Zeichen einer gesteigerten Vorhofvulnerabilität auf. Sie wurden der sog. Vulnerabilitätsgruppe zugeordnet. Die Gruppe der verbleibenden 40 Patienten wurde als Normalgruppe bezeichnet. Die statistische Auswertung ergab in der Vulnerabilitätsgruppe signifikant längereP-Wellen (p<0,05), kürzere effektive (p<0,001) und längere relative Refraktärzeiten des rechten Vorhofes (p<0,001), als in der Normalgruppe.

Summary In the majority of cases the acquired complete atrioventricular block is caused by a complete bilateral bundle branch block and not due to failure of conduction in the region of the AV node or the bundle of His. Intraventricular conduction disturbances of different types during the phase of supraventricular conduction were found in 75.5% of 65 patients with advanced high grade or complete AV block and Adams-Stokes attacks.

Summary The study of 1313 time intervals from 146 patients with acute myocardial infarction showed that a linear relationship exists between the occurrence of ventricular ectopic beats or runs of ventricular ectopic beats and the heart rate. With faster heart rates, the percentage of these arrhythmias is decreased. Ventricular tachycardias and ventricular fibrillation or flutter were also seen most commonly in bradycardia, but there was a second maximum in frequencies exceeding 110/min. It is supposed that in cases with such tachycardial heart action severe heart failure and myocardial hypoxia are often present and that under these circumstances, only relatively few ventricular ectopic beats are necessary to trigger ventricular tachycardias or ventricular flutter/fibrillation.

Summary The impulse conduction in the left ventricle is maintained by two subdivisions of the left bundle branch, the left anterior and posterior fascicle. The classification of intraventricular conduction disturbances may be extended by the knowledge that the left fascicular blocks are recognizable by typical changes of the main frontal QRS axis: The two hemiblocks can be added to the typical left and right bundle branch block patterns. They occur alone or in combination with each other.

Zusammenfassung 1. Die Ergebnisse der feingeweblichen, elektronenoptischen und histochemischen Untersuchungen am Reizleitungssystem sowie die normale Gefäßversorgung dieses Systems werden beschrieben.

Abstract: A visual-display unit, for the simultaneous display of two X ray images together with the results of physiological measurements in the form of digital instantaneous readings and continuous diagrams, with a facility for the keyboarding of patients' names and numbers with comments into the same video field, is demonstrated and discussed with particular reference to its application to the cardiac-catheterisation laboratory.

Abstract: The authors describe the construction and procedure for insertion of a flexible electrode designed to overcome the problem of dislocation. The hollow electrode tip contains a movable bolt which carries platinum-iridium hooks for myocardial fixation; the hooks are actuated by a stylet passing through the hollow connection between electrode tip and pacemaker. Results of animal experiments and time-variation measurements of the stimulation threshold are summarised.

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Zusammenfassung In der vorliegenden Arbeit werden die elektrokardiographischen Befunde von 71 Patienten mit unkomplizierter Aortenisthmusstenose beschrieben und besprochen. Eine Hypertrophie bzw. eine Hypertrophie und Schädigung der linken Herzkammer läßt sich in 63% der Fälle elektrokardiographisch nachweisen. Dabei erweisen sich die Brustwandableitungen als empfindlicher als die Gliedmaßableitungen. Aus dem Index von

Summary The recording of His bundle potentials in patients with bundle branch block allows separate analysis of the conduction in the atrioventricular node and the rest of the His-Purkinje system. The mean value of the conduction time in the His-Purkinje system (HV-time) of 16 patients with a bundle branch block pattern in the ECG was 63 (40–100) ms. This value was significantly (p<0.05) higher than the mean HV-time (41 ms) of 13 patients with a normal QRS (30–50 ms). The intraventricular conduction time was more than 60 ms in 6 of 11 patients with a right bundle branch block and left anterior divisional block and in 4 of 5 patients with a left bundle branch block. The prolonged HV-time (>60 ms) in patients with bundle branch block suggests bilateral lesions in the His-Purkinje system.

The prophylactic value of lidocaine in the treatment of cardiac arrhythmias in acute myocardial infarction has been assessed quantitatively in 89 patients by continuous monitoring of the ECG. Patients with ventricular fibrillation, flutter or tachycardia on admission, with severe left heart failure or cardiogenic shock were excluded from the study. 41 of the 89 were treated with lidocaine (28:20–30 mg/kg; 13:31–60 mg/kg) and 48 controls received no antiarrhythmic treatment. Ventricular ectopic beats and runs of ventricular extrasystoles were equally common in groups receiving low and high doses of lidocaine. 7.3% of the patients treated prophylactically had ventricular tachycardias and they occurred in 10.4% of the untreated controls. Primary ventricular fibrillation caused the death of one control patient. No other difference in mortality was observed between the groups. 1st and 2nd degree AV-block was observed increasingly often in both groups during the monitoring period. The incidence of AV-block increased two-fold from the first to the third day in the lidocaine group compared with the untreated patients. It is concluded that lidocaine cannot be recommended as a general prophylatic treatment in acute myocardial infarction.

Summary Electrocardiographic and vectorcardiographic data of 25 patents with ventricular septal defect were analysed to find out whether the statement of hypertrophy of one or both ventricles might be principally improved by using vectorcardiographic in addition to electrocardiographic criteria.

Zusammenfassung Eine Einteilung und kurze Beschreibung der angeborenen Mißbildungen des Herzens und der großen Gefäße gibt einen Überblick über die Vielzahl der in Betracht kommenden Abnormitäten. Bei der Differenzierung dieser einzelnen Herzfehler sind heute Herzkatheterismus, Blutgasanalyse und intrakardiale Druckmessung wesentliche Hilfsmittel. In der vorliegenden Mitteilung wird über 57 Fälle von angeborenen Herz- und Gefäßmißbildungen berichtet, die typischen Befunde bei den genannten Untersuchungsmethoden werden herausgestellt.

The UCG is the motion curve of different heart structures. It permits highly accurate grading of mitral stenosis with or without coexisting insufficiency. Except examination of calcified valves by X-ray films there is no other means of recording the movement of the mitral cusps.In some cases the motion of the tricuspid valve and in exceptional cases that of the aortic valves can be registered. Atrial tumours are rarities, they produce a characteristic echogram. It is possible to detect pericardial effusion.

Zusammenfassung Tierexperimentell wurde nachgewiesen, daß Hunde die Entfernung eines Herzohres überleben. Das Elektrokardiogramm zeigte nach dem Eingriff keine Abweichungen gegenüber dem präoperativen Befund. Die Resektionsstellen an der Herzohrbasis wiesen histologisch neben reaktionslosem Narbengewebe einen vollständigen Endokardüberzug auf.