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R T van Dam

Publications and source records attributed to R T van Dam.

At least 19 recordsLinked to original sources

Body surface maps and the conventional 12-lead ECG compared by studying their performances in classification of old myocardial infarction.

The performance of body surface potential maps and the 12-lead ECG in the detection of old myocardial infarction has been compared in a two-group (54 normals; 52 infarctions) classification procedure (linear discriminant analysis). Three methods for data reduction of body surface maps were compared: 1) time integration, 2) one-step reduction in eigenvectors and 3) two-step reduction in spatial and temporal eigenvectors. Features were taken from the reduction variables by a stepwise selection procedure. From 90% to 93% correct classifications could be obtained using three features from the map data over the initial 30 ms (Q interval) of the QRS wave for all three methods considered. Using the 100 ms (QRS) interval 86% correct classifications were obtained using method 1, and up to 90% and 87% for methods 2 and 3, respectively. In a further analysis the classification based on body surface maps was compared to the one based on the 12-lead ECG. The 12-lead ECG was treated as a restricted set of the body surface mapping leads, so the same methods of data reduction, feature extraction and classification could be applied to both sets of data. Applying method 1 (time integration) 89% correct classifications were obtained using data taken from the 30 ms interval of the 12-lead ECG and a subsequent reduction to three features. When using the 100 ms interval the result was 79% also using three features. The results of method 2 applied to the 12-lead ECG were 89% (30 ms interval, three features) and 78% (100 ms interval, three features).

Electrocardiography

[Surgical interruption of the accessory pathway in a case of WPW-syndrome with persistent supraventricular tachycardia provoked by sinus node suppression (author's transl)].

This is a case report of a 60-year-old woman with a WPW-syndrome Type A developing persistent supraventricular tachycardia refractory to medical treatment. The re-entry mechanism was based on av-junction escape beats leading to retrograde conduction through the accessory pathway in presence of sinus node dysfunction i.e. long periods of sinus arrest probably enhanced through antiarrhythmic drug therapy and/or digitalis. With the aid of electrophysiological examinations and intraoperative epicardial mapping the accessory pathway was located in the upper lateral region of the left ventricle and interrupted by an incision in the av-groove from inside of the lfet atrium. Although an additional accessory pathway, not interrupted by surgery was suggested by the postoperative electrophysiological study, the patient remained free from tachycardia over more than 18 months, except for one episode terminated promptly by overdrive pacing from the right atrium. Postoperatively sinus bradycardia and av-junctional escape rhythm prevailed.

Accessory Nerve

Electrical activation of ventricles and interventricular septum in hypertrophic obstructive cardiomyopathy.

In 10 cases with proven left ventricular outflow obstruction, we studied the time sequence of activation at the epicardial surface, in the left ventricular wall, and in the interventricular septum by means of epicardial exploration and intramural needle electrodes carrying 10 to 20 terminals, during surgical exposure. A variable delay (15-40 msec) was found in subendocardial activation of the anterior paraseptal left ventricular wall, probably caused by a block in the anterior division of the left bundle-branch. Epicardial excitation is additionally retarded by the increased diameter of the left ventricular wall because of hypertrophy. Conduction velocity in the left ventricular wall and in the interventricular septum was found to be approximately normal: +/-45 cm/sec; activation of the hypertrophic interventricular septum starts at normal times and proceeds mainly from left to right, with a smaller contribution from right to left; both fronts meet to the right of the middle of the interventricular septum; total septal activation time is prolonged because of hypertrophy.

Adolescent

[Cardioversion].

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Arrhythmias, Cardiac