Analysis of heart rate variability (HRV) with Holter monitoring is often difficult due to excessive artifacts and arrhythmias. While short sudden surges are treated successfully by most methods, slow heart rate (HR) variations, nocturnal trapezoidally-shaped HR increases and special types of arrhythmias which are similar to normal HRV fluctuations may distort further time domain and spectral analysis. This paper examines the advantages and disadvantages of different methods for preprocessing of HR data. We have developed the following approach to the analysis of HRV. (1) A combination method based on the absolute difference between HR values and both the last normal HR value and an updated mean is used for removal of artifacts and arrhythmias. This method can detect both sudden surges in HR values as well as longer periods of noise combined with slow normal variations. An additional stage of wild point removal is then optionally applied. (2) Certain special problems such as large T-waves, bigeminal rhythm, slow HR variations and nocturnal trapezoidally-shaped HR increases are also identified. Although none of the algorithms can be applied successfully to all cases, the final computer analysis for preprocessing described in the present study has proved to be superior to the simplified methods which are usually used and provides more suitable data for HRV analysis.

Algorithms↗

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Left subclavian vein puncture for insertion of Swan-Ganz catheters.

A rapid, safe, and reliable method for insertion of Swan-Ganz flow-directed, balloon-tipped catheters using the left subclavian vein is described. Experience with this method in 24 consecutive patients indicates a distinct advantage over the antecubital fossa approach: A venous cutdown is not necessary, the pulmonary artery is readily entered, fluoroscopy is not required, the patient is free to move both arms, and thrombophlebitis and infection occur infrequently. With proper attention to landmarks such as the clavicular tubercle, the procedure may be performed with facility. The major complication, pneumothorax, is minimized if mechanical ventilators are briefly disconnected during the subclavian puncture.

Cardiac Catheterization↗

PubMedDate not supplied

A miniature segment-length strain gauge arch for the assessment of myocardial function.

A miniature myocardial segment-length strain gauge arch utilizing solid-state strain gauge elements is described. The arch weighs 0.25 g, has a frequency response flat to 30 Hz, requires simple circuitry, and is stable in situ for periods exceeding 6 hours. Its miniaturization and ease of insertion offer distinct advantages over similar devices previously described. Miniature arches have been applied simultaneously to multiple sites to assess left ventricular function in dogs. The response of these arches to a variety of interventions indicates that this device may be used to follow localized segment-length and velocity changes. The study also clearly demonstrates that the orientation of strain gauge arches with respect to muscle fiber direction in the ventricular wall qualitatively and quantitatively affects the recorded segment-length alterations.

Animals↗