Advances in Noninvasive Electrocardiographic Monitoring Techniques(Developments in Cardiovascular Medicine Series, Volume 229)

Author: Hans-H. Osterhues
Published: March 2000
Publisher: Kluwer Academic Publishers
ISBN: 0792362144
Hardcover Book
Number of Pages: 493

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This multiauthored text is an overview of current developments in noninvasive electrocardiography monitoring techniques. The papers were presented at the 8th International Congress on Holter and Noninvasive Electrocardiology. The purpose is to provide a comprehensive overview of the current state and future developments in noninvasive electrocardiographic monitoring techniques. The editors' objectives are met. Clinician scientists in the field of electrocardiographic techniques will find this text most useful, but cardiologists and internal medicine physicians who regularly interpret electrocardiograms will find it very interesting. This text is divided into sections on basic research in pathophysiology, the electrocardiogram, ischemic heart disease implications, methods, heart rate variability, exercise electrocardiography, cardiopulmonary exercise testing, blood pressure monitoring, and even magnetocardiography. Contributors present analyses utilizing nonlinear dynamics, high resolution electrocardiographic signaling, and cardiac computer models. The text has good sections on the long QT interval problems and the effects of the autonomic nervous system as measured by baroreflex sensitivity and heart rate variability. There are also interesting discussions on T-wave alternans (T-wave alternans may soon be available on routine ambulatory electrocardiographic monitoring). Baroreceptor sensitivity and heart rate variability are considered markers of cardiac stability of autonomic activity. QT analysis can be very difficult because of the problem of evaluating the end of the T-wave, but it may have usefulness in evaluation of QT interval dispersion. The section on ischemia isparticularly interesting with evaluations of electron beam computer tomography, magnetic resonance imaging, as well as technesium pyrophosphate, thallium, and PET scanning. The methods portions of these areas are particularly interesting and important to different aspects of electrocardiographic monitoring. Illustrations and graphs are particularly plentiful and helpful. The index is well done and detailed. This is a welcome addition to the literature on the electrocardiogram. The editors show the broad spectrum of noninvasive electrocardiographic techniques available to the clinician and the clinician scientists. This book is a collection of current information presented by a group of international experts in the science and practice of noninvasive electocardiography. An outgrowth of the Biennial International Congress on Holter and Noninvasive Electrocardiology held in Ulm, Germany, in May 1998. The 46 papers provide a snapshot of the field at the end of the century for clinical cardiologists and internists who use electrocardiographic procedures in managing their patients, researchers actively involved in the field, and students who will be working in it. They cover physiology and pathophysiology from genes and phenotypes to the autonomic nervous system, aspects investigated by different methods such as P-wave and QRS and T-wave alternans/repolarization, ischemic heart disease, ambulatory blood pressure monitoring and other methods, and non-linear dynamics and newer signal detection and analysis techniques. Osterhues, Hans-H. (Univ of Ulm); Hombach, Vinzenz (Univ of Ulm); Moss, Arthur J. (Univ of Rochester)

Table of Contents
Contributors List
Preface
Introduction
Ch. 1 Physiology and Pathophysiology
Sect. 1 Basic Research: From Gene to Phenotype 1
Cardiovascular molecular genetics 3
Dilated cardiomyopathy and arrhythmogenic right ventricular dysplasia: From gene to phenotype 19
Heart failure: From gene to therapy 27
Sect. 2 Autonomic Nervous System 39
Autonomic Nervous System: Physiology and pathophysiology 41
Methods to assess baroreflex sensitivity as a measure of the activity of the autonomic nervous system 51
Role of the Autonomic Nervous System in cardiovascular diseases 59
Therapeutical options to influence the autonomic nervous system 69
Ch. 2 ECG aspects investigated by different methods
Sect. 1 P-wave and QRS 87
The signal averaged P-wave 89
Wenckebach pattern of ventricular late potentials 99
Detection of QRS-variability 109
Sect. 2 QT-variability/QT dispersion 121
QT-Dispersion: Role in clinical decision making 123
Dynamic QT-interval analysis 131
QT-variability: Clinical results and prognostic significance 143
Heart rate dependency of QT-Interval in congenital and acquired prolonged ventricular repolarisation: Long-term analysis by Holter Monitoring 155
Sect. 3 T-wave alternans / repolarization 161
Modern approaches to assessment of ventricular repolarisation 163
Dynamicity of T-wave alternans: Measurement and role in sudden death 177
Macrovolt T-wave alternans: pathophysiology and link with repolarization-dispersion 191
T-wave alternans and variability: prognostic, diagnostic and therapeutic implications 201
Ch. 3 Focus on: Ischemic Heart Disease 209
Non-invasive quantification / localisation of myocardial ischemia 211
Ambulatory ECG, myocardial ischemia and risk stratification 217
Post thrombolysis / post PTCA-monitoring 223
Interactive Holter-monitoring of transient ischemic episodes 233
Silent ischemia: The 1998 status: new observations on triggers, pathophysiological mechanisms and circadian variations 239
Circadian variation in myocardial ischemia and infarction 247
Chronopharmacology - Implications for diagnosis and treatment 263
Beta blockers following acute myocardial infarction 279
The United States Multicenter Study of enhanced external counterpulsation (MUST-EECP) 283
Ch. 4 Methods
Sect. 1 Quality control and standardization of monitoring techniques 287
Heart rate variability: A simple methodology with several unrecognized technical and methodological problems 289
Quality control and standardization: High resolution ECG 297
Sect. 2 Exercise ECG 303
Diagnosis of myocardial viability: Contribution of the ECG 305
Exercise testing for risk stratification 317
Cardiopulmonary exercise testing: cardiovascular and respiratory limitations detected by exercise gas exchange 331
Sect. 3 Ambulatory Blood Pressure Monitoring 341
White-coat hypertension: State of the art 343
Should antihypertensive treatment by guided by casual measurement or through Ambultory Blood Pressure Monitoring 351
Non-invasive pulse wave velocity as a method to evaluate physical properties of the large arteries in aging and hypertension 359
Prognostic implications of blood pressure variability 371
Sect. 4 Magnetocardiography 381
Magnetocardiographic technology: State of the art 383
Ischemia and hibernation in magnetocardiography 393
MCG at the turn of the millenium 401
Ch. 5 Analysis Techniques
Sect. 1 Non-linear dynamics 411
Methods of non-linear dynamics 413
Heart rate variability and non-linear dynamics 421
Symbolic dynamics 429
Sect. 2 Newer signal detection and analysis techniques 439
Neural classification in high-resolution ECG signal processing 441
Cardiovascular system identification 453
Maximum likelihood analysis in ECG signal processing 463
What can cardiac computer models tell us about arrhythmogenesis 471
Index 481

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