==================================HSR41================================== 41. Real time cardiac monitors. 1 UI - 87051525 AU - Levin RI ; Cohen D ; Frisbie W ; Selwyn AP ; Barry J ; Deanfield JE ; Keller B ; Campbell DQ TI - Potential for real-time processing of the continuously monitored electrocardiogram in the detection, quantitation, and intervention of silent myocardial ischemia. AB - Current technology for monitoring and analyzing the ST segment allows for accurate description of ST-segment deviation, which in most cases is a valid measure of myocardial ischemia. In this article, the authors describe a new method that utilizes microprocessor analysis of the electrocardiogram to detect ST-segment deviation in ambulatory subjects. This technique results in the ability to characterize the total ischemic burden over long periods of time and to intervene acutely in order to treat myocardial ischemia and possibly to prevent complications of coronary artery disease. MH - Algorithms ; Computer Systems ; *Computers ; Coronary Disease/*DIAGNOSIS/ DRUG THERAPY ; *Electrocardiography ; Glyceryl Trinitrate/THERAPEUTIC USE ; Human ; *Microcomputers ; Monitoring, Physiologic/*INSTRUMENTATION ; Support, Non-U.S. Gov't ; Tape Recording SO - Cardiol Clin 1986 Nov;4(4):735-45 2 UI - 87028639 AU - Veltri EP ; Griffith LS ; Platia EV ; Guarnieri T ; Reid PR TI - The use of ambulatory monitoring in the prognostic evaluation of patients with sustained ventricular tachycardia treated with amiodarone. AB - We recently reported a retrospective experience with serial Holter monitoring as a guide to therapy in patients with sustained ventricular tachycardia treated with amiodarone. To confirm and substantiate these findings, a prospective study was designed that included baseline 24 hr Holter monitoring and serial Holter monitoring after 1 week of therapy with amiodarone. Fifty-two patients with documented sustained ventricular tachycardia who manifest nonsustained ventricular tachycardia on baseline Holter monitoring were treated with amiodarone. Thirty-four patients (group I) had nonsustained ventricular tachycardia completely suppressed and 18 patients (group II) had continued nonsustained ventricular tachycardia on serial Holter monitoring performed on days 8, 9, and 10 of therapy. At 11.6 +/- 1.0 (mean +/- SE) months follow-up, three (9%) group I patients and 12 (67%) group II patients had recurrent sustained ventricular tachycardia or sudden cardiac death (p less than .01). The sensitivity, specificity, positive and negative predictive value, and predictive accuracy of ventricular tachycardia on 24, 48, and 72 hr Holter monitoring over days 8, 9, and 10 for predicting recurrent sustained ventricular tachycardia or sudden cardiac death were analyzed. The positive and negative predictive values were 89% and 84%, 69% and 89%, and 67% and 91% for 24, 48, and 72 hr Holter monitoring, respectively. Overall predictive accuracy was 85%, 83%, and 83%, respectively. We conclude that early Holter monitoring is useful in assessing the clinical efficacy of amiodarone in patients with sustained ventricular tachycardia who manifest nonsustained ventricular tachycardia on baseline Holter monitoring. MH - Amiodarone/*THERAPEUTIC USE ; Electrocardiography/*METHODS ; Evaluation Studies ; Female ; Follow-Up Studies ; Heart Ventricle ; Human ; Male ; Middle Age ; *Monitoring, Physiologic ; Prognosis ; Prospective Studies ; Support, U.S. Gov't, P.H.S. ; Tachycardia/*DRUG THERAPY SO - Circulation 1986 Nov;74(5):1054-60 3 UI - 87001615 AU - Biagini A ; L'Abbate A ; Emdin M ; Testa R ; Mazzei MG ; Carpeggiani C ; Michelassi C ; Andreotti F ; Marchesi C ; Benassi A TI - Electrocardiographic monitoring: temporal versus spatial information and data processing. AB - In the diagnosis of ischemic heart disease, long-term electrocardiographic recording has several distinct advantages. It allows one to relate patient symptoms to cardiac disturbances and to detect asymptomatic events, furnishes the whole spectrum of electrocardiographic alterations accompanying ischemic attacks, reveals the possible ischemic genesis of dysrhythmias, and is the most suitable method to assess the acute and chronic effectiveness of treatment and the evolution of the disease. In addition to its valuable application in the screening and follow-up of ambulatory patients, its use in the Coronary Care Unit is of great interest, being in this context much more sensitive than visual electrocardiographic monitoring. In spite of these advantages, Holter monitoring has several limitations: the recording and replay systems are below recommended standards; the analysis of a single lead is responsible in most systems for the low sensitivity in detecting ischemia occurring in unexplored regions; the period of 24-48 hours, usually adopted for Holter monitoring, may not be sufficient for screening patients with suspected myocardial ischemia due to the unpredictable spontaneous variability of the disease; a common standard of analysis is still lacking and a reliable computerized analysis is needed to manage data overflow. In conclusion, although further research and technical developments are desired to improve reliability and data processing, the role of Holter monitoring appears essential in the ambulatory screening of patients with suspected ischemia for a better characterization of patients with ascertained myocardial ischemia, and for the evaluation of treatment and of the evolution of the disease. MH - Angina Pectoris, Variant/DIAGNOSIS/PHYSIOPATHOLOGY ; Arrhythmia/ PHYSIOPATHOLOGY ; Coronary Disease/*DIAGNOSIS ; Data Display ; Electrocardiography ; Human ; *Monitoring, Physiologic ; Pain/ PHYSIOPATHOLOGY ; Support, Non-U.S. Gov't ; Time Factors SO - Can J Cardiol 1986 Jul;Suppl A:142A-148A 4 UI - 86319926 AU - Tzivoni D ; Gavish A ; Benhorin J ; Keren A ; Stern S TI - Myocardial ischemia during daily activities and stress. AB - Twenty-four-hour, 2-channel Holter monitoring during daily activities was performed in 210 patients; during the same day a Bruce protocol treadmill test was also performed and the electrocardiogram was recorded using the same Holter system. Significant ST-segment depression was observed during daily activities in 97 patients, while similar changes were recorded during the treadmill test in 122 patients. Thus, 77% of patients with ST depression during the provocation of the treadmill test had ischemic episodes during their everyday life. On the other hand, 3 patients with proven significant coronary artery disease had spontaneous ischemic episodes during daily activities, but had a negative stress test. The ischemic changes during daily activity developed at a lower heart rate than during stress testing (94 beats/min vs 109 beats/min, respectively, p less than 0.05). A total of 351 ischemic episodes were recorded during daily activities, 241 (69%) of these were asymptomatic. In 46 patients all episodes were asymptomatic, in 15 all were symptomatic, while in 36 both symptomatic and silent episodes were detected. The mean duration of the symptomatic episodes was 13.7 minutes and that of the asymptomatic ones was 14.9 minutes (difference not significant). The degree of ST depression in these 2 groups was also similar. Because of more advanced symptomatology in 143 patients, coronary arteriography was performed; 43 had normal and 100 had pathologic coronary arteries. In this selected group, the sensitivity of Holter monitoring during daily activity was 87% and during stress 97%; the specificity during daily activity was 95% and during stress 88%.(ABSTRACT TRUNCATED AT 250 WORDS) MH - *Activities of Daily Living ; Adult ; Aged ; Coronary Disease/*DIAGNOSIS/ PHYSIOPATHOLOGY ; *Electrocardiography ; Exercise Test ; *Exertion ; Female ; Heart Rate ; Human ; Male ; Middle Age ; *Monitoring, Physiologic SO - Am J Cardiol 1986 Aug 15;58(4):47B-50B 5 UI - 86319922 AU - Nademanee K ; Intarachot V ; Singh PN ; Josephson MA ; Singh BN TI - Characteristics and clinical significance of silent myocardial ischemia in unstable angina. AB - The frequency and duration of transient myocardial ischemia on Holter recordings, analyzed by the compact analog technique, were determined in 41 patients (all men, mean age 54) with unstable angina (33 with angiographic evidence). There were 781 episodes of ischemia: 392 (50%) with ST-segment depression, 242 (31%) with ST elevation, 45 (6%) with ST elevation and depression in different leads, 70 (9%) with pseudonormalization of T waves and 32 (4%) with T-wave augmentation. Ventricular arrhythmias were associated with 18% of the episodes. The mean duration of ischemic episodes was 14 minutes (range 30 seconds to almost 12 hours); most were less than 5 minutes. Only 154 (20%) of the 781 episodes of ischemia were associated with pain. Conversely, 77 episodes of chest pain were not associated with electrocardiographic changes. Analysis of the temporal sequence of heart rate during the development of ischemia (analyzed in 415 episodes) showed that in only 43 (10%) the heart rate at the beginning of ischemia was significantly (greater than 6 beats/min) higher than that at 5 minutes (baseline) before the onset of ischemia. At the peak of the ischemic abnormality, the mean heart rate increase was 10% and returned to baseline at the end of the ischemic episode. The data indicate that 80% of ischemic episodes in unstable angina are silent and over 90% are not triggered by increases in heart rate; apparently increased oxygen demand is an uncommon cause of ischemia in unstable angina. Although most of the episodes were short-lived, some were extremely protracted without the development of myocardial infarction. The findings are of therapeutic significance. MH - Adult ; Aged ; Angina Pectoris/*DIAGNOSIS ; Angina, Unstable/*DIAGNOSIS/ DRUG THERAPY/ETIOLOGY ; Arrhythmia/DIAGNOSIS ; Coronary Circulation ; Coronary Disease/*DIAGNOSIS ; *Electrocardiography ; Heart Rate ; Human ; Male ; Middle Age ; *Monitoring, Physiologic ; Myocardium/METABOLISM ; Oxygen Consumption ; Support, Non-U.S. Gov't ; Support, U.S. Gov't, Non-P.H.S. ; Time Factors SO - Am J Cardiol 1986 Aug 15;58(4):26B-33B 6 UI - 86319921 AU - Selwyn AP ; Shea M ; Deanfield JE ; Wilson R ; Horlock P ; O'Brien HA TI - Character of transient ischemia in angina pectoris. AB - There is growing interest in the possible therapeutic and prognostic significance of silent myocardial ischemia in coronary artery disease (CAD) and its detection by ambulatory electrocardiographic (ECG) monitoring. In 100 apparently healthy normal subjects (20 with angiographically normal coronary arteries), Holter monitoring revealed significant ST-segment depression in only 2 (both over 40 years, one with positive treadmill test, the other with risk factor for CAD). No significant ECG changes were found in those with normal coronary vessels. In 30 patients with documented CAD, significant ST-segment depression during 1,934 episodes over 446 days of monitoring over 18 months was found. Only 24% of the episodes were associated with angina. Asymptomatic and symptomatic episodes were associated with comparable changes in perfusion detected by positron emission tomography. Heart rate increases greater than 10 beats/min preceding the onset of the ST-segment changes occurred in only 23% of the episodes. There was considerable variability in the ST-segment changes in the same patient monitored serially over long periods of time. The data indicate that it is extremely uncommon for patients without CAD to exhibit silent myocardial ischemia, whereas patients with stable angina exhibit frequent, variable and often asymptomatic ECG evidence of myocardial ischemia rarely triggered by increases in heart rate. These findings are likely to be of therapeutic and prognostic significance. MH - Adult ; Aged ; Angina Pectoris/*DIAGNOSIS/PHYSIOPATHOLOGY ; Comparative Study ; Coronary Circulation ; Coronary Disease/*DIAGNOSIS/ PHYSIOPATHOLOGY/RADIONUCLIDE IMAGING ; *Electrocardiography ; Female ; Heart/RADIONUCLIDE IMAGING ; Heart Rate ; Human ; Male ; Middle Age ; *Monitoring, Physiologic ; Prognosis ; Risk ; Support, Non-U.S. Gov't ; Support, U.S. Gov't, Non-P.H.S. ; Time Factors SO - Am J Cardiol 1986 Aug 15;58(4):21B-25B 7 UI - 86319920 AU - Bala Subramanian V TI - Clinical and research applications of ambulatory Holter ST-segment and heart rate monitoring. AB - Monitoring of the electrocardiogram during normal daily activity yields data regarding silent myocardial ischemia and its relation to heart rate in addition to the detection of cardiac arrhythmias. In recent years various techniques have been developed to quantify the frequency and duration of ischemic episodes in patients with ischemic heart disease. Of particular importance are the newer frequency-modulated recording techniques, which ensure adequate low frequency response, and the computerized digital analysis used to define the role of ST-segment monitoring in the clinical and research setting. The techniques used for acquiring artifact-free signals, the methods of data analysis and the clinical role of ambulatory Holter monitoring of ST-segment changes in the diagnosis of Prinzmetal's angina, in chronic stable angina and in the detection of calcium antagonist withdrawal syndrome in angina are discussed. The data indicate the particular utility of Holter monitoring to analyze the variability of heart rate in defining the effects of calcium-channel blockers, beta-adrenergic blocking agents and their combined use in pharmacologic therapy of ischemic myocardial syndromes. MH - Adrenergic Beta Receptor Blockaders/THERAPEUTIC USE ; Aged ; Angina Pectoris/CHEMICALLY INDUCED ; Angina Pectoris, Variant/DIAGNOSIS ; Blood Pressure ; Case Report ; Coronary Circulation ; Coronary Disease/ *DIAGNOSIS/DRUG THERAPY ; Diltiazem/ADVERSE EFFECTS/THERAPEUTIC USE ; *Electrocardiography ; Female ; *Heart Rate ; Human ; Male ; Middle Age ; *Monitoring, Physiologic ; Myocardial Contraction ; Nifedipine/ THERAPEUTIC USE ; Substance Withdrawal Syndrome/DIAGNOSIS ; Support, Non-U.S. Gov't ; Time Factors ; Verapamil/ADVERSE EFFECTS/THERAPEUTIC USE SO - Am J Cardiol 1986 Aug 15;58(4):11B-20B 8 UI - 86265310 AU - Suyama A ; Anan T ; Araki H ; Takeshita A ; Nakamura M TI - Prevalence of ventricular tachycardia in patients with different underlying heart diseases: a study by Holter ECG monitoring. AB - Twenty-four-hour Holter ECGs were recorded in 1089 patients. Ventricular tachycardia (VT) was observed in 184 tapes obtained from 81 patients (73 men and 8 women). Underlying heart diseases were present in 72 patients and no organic heart diseases were found in nine patients. The analysis of continuous 1-hour rhythm strips immediately before VT revealed that, in ischemic heart disease and hypertrophic cardiomyopathy, there was no correlation between the incidence of VT and the number or complexity of premature ventricular complexes (PVCs) within 1 hour before VT. In contrast, frequent or multiform PVCs were often observed during the pre-VT period in the patients with rheumatic heart disease or dilated cardiomyopathy. These findings suggest that the mechanism of VT may be different among the various underlying heart diseases. In addition, the mode of initiation of VT was evaluated. Only few episodes of VT occurred with the prematurity index value smaller than 1.0 or the vulnerability index value greater than 1.1. The correlation between the rate of VT and the preceding sinus rate was not significant, and the correlation between the rate of VT and the coupling interval of VT was weak. These facts suggest that the malignancy of VT, represented by the rate of VT, cannot be predicted by the preceding sinus rate or by the coupling interval of VT. MH - Adult ; Aged ; *Electrocardiography ; Female ; Heart/PHYSIOPATHOLOGY ; Heart Diseases/COMPLICATIONS/*PHYSIOPATHOLOGY ; Heart Rate ; Heart Ventricle/PHYSIOPATHOLOGY ; Human ; Male ; Middle Age ; *Monitoring, Physiologic ; Support, Non-U.S. Gov't ; Tachycardia/DIAGNOSIS/*OCCURRENCE/ PHYSIOPATHOLOGY SO - Am Heart J 1986 Jul;112(1):44-51 9 UI - 86265279 AU - Kim SG ; Seiden SW ; Matos JA ; Waspe LE ; Fisher JD TI - Discordance between ambulatory monitoring and programmed stimulation in assessing efficacy of mexiletine in patients with ventricular tachycardia. AB - Programmed electrical stimulation (PES) and 24-hour Holter monitoring were compared in 30 patients with ventricular tachycardia (VT) or ventricular fibrillation (VF) before and during treatment with mexiletine. Before treatment, all patients had greater than or equal to 30 ventricular premature complexes (VPCs)/hr and 22 patients had nonsustained VT on Holter. All had inducible sustained VT by PES (one to three extrastimuli). Mexiletine was effective in only 23% by PES criteria (VT no longer inducible or less than or equal to 15 beats in duration and effective in 57%, 57%, and 73% by Holter criteria I, II, and III, respectively (Holter I greater than or equal to 50% reduction of VPCs, greater than or equal to 90% reduction of couplets and abolition of nonsustained VT; Holter II greater than or equal to 83% reduction of VPCs and abolition of VT; Holter III abolition of VT in patients who had VT during baseline Holter). Results of PES and Holter were discordant in 67%, 60%, and 55% (PES vs Holter I, II, and III, respectively). The majority (greater than or equal to 75%) of the discordance occurred due to mexiletine appearing effective by Holter criteria but ineffective by PES criteria (suggesting insensitivity of efficacy by Holter criteria and/or nonspecificity of induced VT during treatment with mexiletine). Conclusions: PES and Holter are discordant in assessing efficacy of mexiletine (p less than 0.05). Efficacy of mexiletine by Holter criteria is easier to achieve than efficacy by PES. The discordance between the two methods, both with very good reported predictive values, calls for randomized clinical follow-up studies to determine sensitivity and specificity of each method in assessing efficacy of mexiletine. MH - Comparative Study ; Drug Evaluation ; *Electric Stimulation ; *Electrocardiography ; Evaluation Studies ; Female ; Heart Ventricle ; Human ; Male ; Mexiletine/PHARMACODYNAMICS/*THERAPEUTIC USE ; Middle Age ; *Monitoring, Physiologic ; Propylamines/*THERAPEUTIC USE ; Tachycardia/ *DRUG THERAPY/ETIOLOGY ; Ventricular Fibrillation/DRUG THERAPY SO - Am Heart J 1986 Jul;112(1):14-9 10 UI - 86232732 AU - Fisher JD ; Kim SG ; Waspe LE ; Johnston DR TI - Amiodarone: value of programmed electrical stimulation and Holter monitoring. AB - The value of programmed electrical stimulation (PES) and Holter monitoring in the assessment of amiodarone efficacy was reviewed. Many physicians have been disturbed by the persistent inducibility of arrhythmias in patients treated with amiodarone, who nevertheless do very well during the follow-up period. Noninducibility was associated with a favorable prognosis among 366 VT patients. Eighty-eight (24%) were noninducible on amiodarone, and 10% of these had recurrences, vs 39% in patients who remained inducible. Further, increased difficulty of induction with PES or induction of a slower or better tolerated VT may indicate a favorable outlook, and add to the value of PES. Few papers rigorously employed Holter monitoring in the assessment of amiodarone. In general, suppression of previously frequent arrhythmias implies excellent protection for patients with benign arrhythmias and moderate protection with malignant arrhythmias. By Holter assessment in 186 VT patients, arrhythmias were suppressed in 114 (61%), and 18% of these had recurrences vs 50% in patients whose arrhythmias were not suppressed. Studies attempting to correlate the results of PES and Holter monitoring in the same patients are lacking and may prove useful. MH - Amiodarone/ADMINISTRATION & DOSAGE/*THERAPEUTIC USE ; Arrhythmia/*DRUG THERAPY ; Atrial Fibrillation/DRUG THERAPY ; Benzofurans/*THERAPEUTIC USE ; *Cardiac Pacing, Artificial ; Clinical Trials ; *Electrocardiography ; Electrophysiology ; Female ; Follow-Up Studies ; Heart Conduction System/ PHYSIOPATHOLOGY ; Human ; Male ; Middle Age ; *Monitoring, Physiologic ; Pre-Excitation Syndromes/DRUG THERAPY ; Prognosis ; Review ; Tachycardia/ DRUG THERAPY SO - PACE 1986 May;9(3):422-35 11 UI - 86183660 AU - Krucoff MW ; Green CE ; Satler LF ; Miller FC ; Pallas RS ; Kent KM ; Del Negro AA ; Pearle DL ; Fletcher RD ; Rackley CE TI - Noninvasive detection of coronary artery patency using continuous ST-segment monitoring. AB - Continuous ST-segment Holter recordings were analyzed from 46 patients with acute myocardial infarction (AMI) receiving intracoronary streptokinase (SK) during the first 48 hours of hospitalization. Changes in ST deviation and the time periods of these changes were quantitated and correlated with angiographic evidence of reperfusion. Thirty-six patients had total occlusion of the infarct vessel and 10 had subtotal occlusion. Of the 36 vessels that were totally occluded, 19 were reperfused and 17 were not. In patients in whom reperfusion was successful, an ST steady state was achieved 55 +/- 32 minutes after SK administration. In patients in whom it was not successful, a steady state was achieved in 219 +/- 141 minutes (p less than 0.001). Achievement of steady state within 100 minutes after SK reperfusion indicated successful reperfusion with 89% sensitivity and 82% specificity. All patients with subtotal occlusion achieved an ST steady state before SK infusion. No patient with total occlusion achieved a steady state before SK. Achievement of ST steady state before SK infusion was 100% sensitive and 100% specific for subtotal occlusion at initial angiography. Continuous, quantitative ST-segment analysis is a sensitive and specific noninvasive technique for following coronary artery patency during AMI. MH - Coronary Vessels/*DRUG EFFECTS ; Human ; *Monitoring, Physiologic ; Myocardial Infarction/DIAGNOSIS/*DRUG THERAPY ; Perfusion ; Streptokinase/ *PHARMACODYNAMICS/THERAPEUTIC USE ; Time Factors SO - Am J Cardiol 1986 Apr 15;57(11):916-22 12 UI - 86180783 AU - Koudstaal PJ ; van Gijn J ; Klootwijk AP ; van der Meche FG ; Kappelle LJ TI - Holter monitoring in patients with transient and focal ischemic attacks of the brain. AB - The results of Holter monitoring in 100 patients with transient and focal cerebral ischemia were studied retrospectively. Atrial fibrillation (AF) was found in five patients compared with two from a group of 100 age and sex-matched control patients. Four of these had a previous history of AF or showed AF on the standard electrocardiogram. Episodic forms of sick sinus syndrome, which have also been related to cerebral embolism, were found in 32 of the TIA patients against 13 of the controls (p less than 0.0025). Sick sinus syndrome was of the bradyarrhythmia-tachyarrhythmia type in 14 of the TIA patients and in three of the controls (p less than 0.01). The relationship between TIAs and transient sinus node dysfunction could not be explained by concomitant heart disease. It is not yet clear whether the relationship is causal or indirect. MH - Adult ; Aged ; Arrhythmia, Sinus/COMPLICATIONS ; Atrial Fibrillation/ COMPLICATIONS ; Carotid Arteries/RADIOGRAPHY ; Cerebral Ischemia, Transient/COMPLICATIONS/*PHYSIOPATHOLOGY ; Female ; Heart Enlargement/ COMPLICATIONS ; Human ; Male ; Middle Age ; *Monitoring, Physiologic ; Retrospective Studies ; Tachycardia/COMPLICATIONS SO - Stroke 1986 Mar-Apr;17(2):192-5 13 UI - 86169322 AU - Sokoloff NM ; Spielman SR ; Greenspan AM ; Rae AP ; Brady PM ; Kay HR ; Horowitz LN TI - Utility of ambulatory electrocardiographic monitoring for predicting recurrence of sustained ventricular tachyarrhythmias in patients receiving amiodarone. AB - The prognostic implications of changes in ventricular ectopic activity on serial 24 hour ambulatory electrocardiographic (Holter) recordings were prospectively evaluated in 107 patients with a history of sustained ventricular tachyarrhythmias treated with amiodarone for at least 30 days. Twenty-seven patients (25%) had insufficient ventricular ectopic activity (less than 10 ventricular premature complexes/h and no repetitive forms) on baseline Holter recordings for serial statistical analysis. In 53 (66%) of the remaining 80 patients, serial 24 hour Holter monitor recordings showed efficacy of treatment, defined as a 75% decrease in ventricular premature complexes, a 95% decrease in ventricular couplets and absence of ventricular tachycardia. During a mean follow-up period of 14.2 +/- 9.9 months, 34 (32%) of the 107 patients had recurrence of a sustained ventricular tachyarrhythmia. Holter recording correctly predicted nine recurrences and correctly identified 37 patients who did not experience a recurrence. Holter efficacy failed to predict recurrence of a sustained ventricular tachyarrhythmia in 16 patients, and 18 patients remained free of recurrence despite failure to achieve Holter efficacy. The positive predictive value of Holter monitoring efficacy was 33% and the negative predictive value was 70%; however, these differences were not statistically significant by chi-square analysis. Similar results were obtained using Holter recordings performed relatively early in therapy (6 weeks and 4 months). Of the 27 patients without significant ventricular ectopic activity on the baseline Holter recording, 9 had an arrhythmia recurrence despite continued infrequent ventricular premature complexes and no repetitive forms on subsequent recordings. The recurrence rate in this group (33%) was similar to the overall recurrence rate.(ABSTRACT TRUNCATED AT 250 WORDS) MH - Aged ; Ambulatory Care ; Amiodarone/*THERAPEUTIC USE ; Benzofurans/ *THERAPEUTIC USE ; *Electrocardiography ; Female ; Heart Ventricle/ PHYSIOPATHOLOGY ; Human ; Male ; Middle Age ; *Monitoring, Physiologic ; Prospective Studies ; Recurrence ; Tachycardia/*DRUG THERAPY/ PHYSIOPATHOLOGY SO - J Am Coll Cardiol 1986 Apr;7(4):938-41 14 UI - 86102307 AU - Malcolm ID ; Cherry DA ; Morin JE TI - The use of temporary atrial electrodes to improve diagnostic capabilities with Holter monitoring after cardiac surgery. AB - The use of temporary atrial electrodes implanted during cardiac surgery has been advocated for diagnosis and treatment of cardiac arrhythmias in the postoperative period. We have adapted this technique to allow continuous ambulatory electrocardiographic (Holter) recording of atrial activity in patients after coronary artery surgery. The electrodes of one of the two leads of the Holter recorder were attached as a surface electrocardiographic lead, while the electrodes of the other were each attached to one of the two implanted atrial wires. The Holter record was then obtained in the usual way. A satisfactory recording of the atrial electrocardiogram and the simultaneous surface electrocardiogram was obtained in all 6 patients and resulted in improved diagnostic capabilities, specifically in differentiating supraventricular and ventricular arrhythmia. As has proven to be true in the post-myocardial infarction setting, arrhythmias that were not noted clinically despite continuous electrocardiographic monitoring were demonstrated on Holter records. MH - Arrhythmia/*DIAGNOSIS/ETIOLOGY ; Electrocardiography/*INSTRUMENTATION ; Electrodes ; *Heart Atrium ; *Heart Surgery ; Human ; Monitoring, Physiologic/*INSTRUMENTATION ; Postoperative Complications ; Postoperative Period ; Support, Non-U.S. Gov't SO - Ann Thorac Surg 1986 Jan;41(1):103-5