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Proceedings of the British Cardiac Society Br Heart J: first published as 10.1136/hrt.28.3.426 on 1 May 1966. Downloaded from Brit. Heart J7., 1966, 28, 426. Proceedings of The British Cardiac Society THE AUTUMN MEETING of the British Cardiac Society COMPUTERS IN CARDIOVASCULAR INVESTIGATION was held at the Royal College of Physicians on Friday, By S. H. Taylor, A. Macdonald, R. Sapru November 26, 1965. The President, SHIRLEY SMITH, (last two introduced), and K. W. Donald took the Chair at 9.0 a.m. during Private Business before handing over to the Chairman, WILLIAM EVANS. 175 The facility with which circulatory measurements members and 75 visitors were present. may be made is imposing considerable restriction on the The second Thomas Lewis Lecture was given at design of circulatory investigations due to the problems 5.0 p.m. by Dr. Bernard Lown on "Cardioversion of of measurement of the data involved. A study was, Arrhythmias ". therefore, designed to explore the practical feasibility of analysing cardiovascular measurements with the aid of a transducer-computer link and digital computer. PRIVATE BUSINESS In addition the accuracy of the three small proprietary 1. The Minutes of the Annual General Meeting, cardiac output computers currently available has been having been published in the Journal (1965, 27, assessed and the problems associated with their opera- 942), were taken as read and confirmed. tion evaluated. 2. The Treasurer reported that cash in the current The combination of these small on-line cardiac account stood at £1,206, deposit account at £100, output monitors in association with off-line data storage and investments at £529. and analysis by digital computation offers important £50 had been paid to the Society of Cardio- advantages not only in routine or research cardiovascular logical Technicians, as arranged, in July. investigation but also in the monitoring of patients The Congress Fund held £12 14s. 9d. in the acutely ill with circulatory disorders. current account, £400 in the deposit account, and http://heart.bmj.com/ investments still stood at £732 18s. 4d. MEASUREMENT OF RIGHT VENTRICULAR £200 was ear-marked for expenses of members END-SYSTOLIC AND END-DIASTOLIC VOLUMES attending the World Congress in New Delhi in BY A THERMODILUTION TECHNIQUE 1966. By R. Balcon (introduced by S. Oram) The Thomas Lewis Lecture Fund held This communication is a preliminary account of £18 7s. 5d. in current account with investments at £1,173 1Os. 2d. experience with a new method of measuring ventricular 3. The Secretary reported that the Annual General volumes. The history and theory of indicator dilution methods on September 24, 2021 by guest. Protected copyright. Meeting would be held on April 14, 1966 in for the assessment of ventricular volumes is reviewed. Cambridge under the Chairmanship of Cole. The application of a thermodilution technique is des- Milstein will be the Local Secretary. cribed in the investigation of various cardiac abnorm- 4. The V World Congress of Cardiology is to be held alities. An analysis of the findings obtained in these in New Delhi from October 30 to November 5, patients is given, and an attempt made to correlate the 1966. changes with other parameters of ventricular function 5. The Autumn Meeting of the Society will be held at such as end-diastolic pressure and stroke output. the Royal College of Physicians on December 1-2, An account is given of some of the difficulties en- 1966. The Dinner will be held at the end of the countered in the application of this technique and some first day. solutions are 6. The Annual General Meeting in 1967 will be held in possible suggested. Belfast on May 18. 7. RIGHT VENTRICULAR VOLUMES ESTIMATED The European Congress of Cardiology will be held BY THE THERMODILUTION TECHNIQUE in Athens in 1968. AFTER RADICAL CORRECTION OF THE After the Scientific Meeting the Society dined together TETRALOGY OF FALLOT at the Royal College of Physcians with Shirley Smith in the Chair. Shirley Smith proposed the health of the By Maylene Wong (introduced) and Michael Dulake guests who included Sir Charles Dodds, Dr. and Mrs. The thermodilution technique for measuring ven- Bernard Lown, and H. G. Lazell, Esq. William Evans tricular volume was applied to subjects in whom the replied. tetralogy of Fallot had been radically corrected. 426 Br Heart J: first published as 10.1136/hrt.28.3.426 on 1 May 1966. Downloaded from Proceedings of The British Cardiac Society 427 A conventional diagnostic right heart catheterization ELECTIVE CIRCULATORY ARREST BY was performed to exclude any shunt. In 9 such patients ARTIFICIAL PACEMAKER a special catheter was introduced, a rapid responding By J. M. Small, S. C. F. Stephenson, T. V. Campkin, thermister bead at its tip being placed in the pulmonary D. J. S. McIlveen (all introduced), and P. H. Davison artery and the side-hole in the right ventricle. Pressures and samples could be obtained through the latter, and During operations on 12 patients with cerebral an- 1-2 ml. of cold saline were injected to obtain a staircase eurysm, the circulation was profoundly reduced or ar- exponential temperature curve from the thermister in the rested by an electrode catheter in the right ventricle, pulmonary artery. Cardiac output was obtained by the which was used to pace the heart at rates up to 240 a Cardio-green dye dilution technique before and after a minute. Electrocardiographic, aortic, and right atrial series of thermodilution curves at rest and under the pressures were monitored. The patients were cooled to influence of infused isoprenaline. 31-32° C. Under these conditions the cardiac output and Forward stroke volume (FSV) was obtained from the systemic blood pressure were very sensitive to the pacing cardiac output. rate. Above 120 a minute there was reduction of both. At rates of 160 or more, systolic pressures below 30 mm. T +1+ 1 Hg were maintained for periods up to 15 minutes with- volume (EDV) = FSV/1 End-diastolic T-Tn out loss of control of cardiac rhythm. With faster where Tn+1 and Tn are differences between the rates and systolic pressures below 20 mm. Hg, ventri- baseline pulmonary artery temperature and those at cular fibrillation usually occurred within 1 to 2 minutes. beats Tn + 1 and Tn on the thermodilution curve. Reversion by D.C. shock and extemal cardiac massage was then used. Elective arrest with ventricular fibril- FSV/EDV = 1 T+ 1. lation has been maintained for periods up to 64 minutes. There has been no morbidity or mortality to date. The End-systolic volume = EDV- FSV. method offers a useful altemative to inflow occlusion. The data were shown and the advantages and limita- tions of the technique discussed. MYOCARDIAL THRESHOLD AND IMPEDANCE IN COMPLETE HEART BLOCK: METHODS FOR ASSESSING EXPERIMENTAL RESULTS AND CLINICAL FUNCTION AND MALFUNCTION APPLICATION OF PAIRED STIMULATION PACEMAKER OF THE HEART By R. D. Judge, T. A. Preston, D. L. Bowers, and J. D. Morris (all introduced by E. Sowton) By Edgar Sowton, Leon Resnekov, Peter Lord, and two introduced) Analysis of 120 pacemaker implants disclosed that the John Norman (the last http://heart.bmj.com/ major causes for failure were (1) lead fracture, (2) The application of closely coupled pairs of electrical battery failure, (3) exit block. Fortunately, component stimuli to the heart provides the most potent inotropic failure has not been a problem. This experience intervention known at present, and also offers a possible emphasized the need for developing indirect methods of method of controlling intractable arrhythmias. The monitoring myocardial threshold and impedance to aid first stimulus of each pair provokes a ventricular con- in exactly identifying malfunction and anticipating traction, but the second stimulus is timed to cause an failure before they manifested themselves clinically. electrical depolarization without any appreciable mech- The circuit design of one unit has made possible the anical activity, so that there are 2 electrical events for development of a simple and safe method of determining each ventricular contraction. (1) threshold, (2) myocardial resistance, (3) electrode on September 24, 2021 by guest. Protected copyright. In 13 dogs, paired stimulation invariably slowed the capacitance, (4) battery level. All parameter measure- heart below its sinus rate, and also slowed tachycardias ments are made extemally (without surgery) by ana- of sinus, ventricular, or supraventricular origin; the lysing various electromagnetic signals emitted by the maximum slowing was by just under 50 per cent. pacemaker. Preliminary studies in dogs have shown Where the arrhythmia had resulted in a low cardiac the following: that the methods are safe; that it is possible output, paired stimulation restored aortic flow to normal. to predict energy values from pulse signal analysis; that In dogs with severe heart failure paired stimulation increases in rate cause increases in threshold. As resulted in a fall in LV end-diastolic pressure, an increase expected, threshold proved to be a function of total in LV DP/DT and LV peak systolic pressure, and a pulse energy. Using calibrated pacemakers, it was dramatic increase in aortic blood flow. The effects possible to measure myocardial resistance and electrode were reversible and highly repeatable, and stimulation at capacitance following human implantation. In a the same rate with single stimuli produced no beneficial series of 20 patients, capacitance varied insignificantly, effects. while resistance increased gradually during the immedi- The technique has been applied clinically in 3 patients ate post-operative period and then became stable. with severe intractable arrhythmias. In one case Myocardial impedance did not always vary directly with clinical and hmmodynamic benefit was obtained for 48 threshold changes. These studies not only demonstrate hours. Since the second stimulus of the pair falls near a simple, practical method of monitoring pacemaker the vulnerable period, there is a risk ofinducing ventricu- function, but also promise a means of studying the lar fibrillation, and this occurred in 1 patient.
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