[Artificial pacemaker in the treatment of tachycardia].
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In 14 patients with symptomatic high-degree AV block, studies were carried out of the effect on physical working capacity when an atrial triggered mode of cardiac pacing (VAT) was substituted for ventricular inhibited pacing (VVI). The tests were designed to elucidate the quantitative relationship between the effect of rate increase and AV synchronization by comparing VVI pacing matched to the same rate as VAT. The work load was increased by 10 W/min. The physical working capacity increased by 25% with VAT as compared with VVI (p less than 0.001). The improvement was entirely attributed to heart rate increase, and not to AV synchronization.
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1. The effect of medullary stimulation on breathing movement was studied in the adult lamprey, Entosphenus japonicus. 2. A single, as well as low frequency (less than 5 Hz) pulses applied extracellularly to the medial part of the medulla (as shown in Fig. 1) produced one-to-one movement (contraction followed by relaxation) of branchial baskets, which are similar in shape, as well as in bilateral synchronization, to spontaneously occurring movement. 3. medullary stimulation never produced active immediate relaxation of branchial baskets. Intravenous application of d-tubocurarine resulted in sustained relaxation of branchial baskets. EMG recorded from branchial muscles always correlated with the phase of contraction of branchial baskets. 4. The rhythm of respiratory movement was reset by driving stimuli at low frequencies. Alteration of driving frequency did not markedly affect the duration of branchial movement. 5. With high frequency stimulation (more than 5 Hz), individual responses fused into one continuous contraction (sustained compression) of branchial baskets; it may be called a systolic arrest or expiratory arrest of breathing movement. 6. After the repetitive stimulation had been turned off, there was a pause in the respiratory movement. This sustained relaxation of branchial baskets may be called a diastolic arrest or inspiratory arrest. During this arrest, applied pulse shocks induced one-to-one movement of branchial baskets. 7. These results were discussed whilst considering an analogy between respiratory rhythmogenesis in the lamprey and cardiac pacemaking in crustacean heart ganglion.
In the GDR the number of patients with pacemakers increases with about 900 new implantations each year. The further decentralisation of the care of patients with pacemakers proposed by the team pacemaker therapy demands the inclusion of more physicians into the care of these patients. The pacemaker systems used at present in the GDR are described as well as the practical approach in the control of the function of the pacemakers is discussed. In the figures typical electrocardiographic pictures of various models of pacemakers are demonstrated.
In 16 patients who had been operated on according to Andersen-Hynes an electrostimulation of the upper urinary passages was carried out. One electrode consisting of a carbon filament was induced into the pelvis of the ureter, a second one with an at least 100 times larger contact surface than in the carbon electrode was placed on the skin. When the motor activity was restored (usually on the 9th to 12th day after operation) the electrostimulation was discontinued. The advantage of the method presented consists in the fact that the electrostimulation takes place in physiologically established time intervals. The presence of a feedback allows to discontinue the electrostimulation in such cases in which the restored independent contractions of the ureter transgressed the given level of 1 mV.
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Modern revolution of science and technology exerts profound and overall influences on the basic research, diagnosis and treatment of cardiovascular diseases. The application of molecular biology has been revealing the nature of cause, pathogenic mechanism, physiology and pathology of cardiovascular diseases, while gene therapy is expected to yield a radical cure of these diseases. The products of modern technology including computerized tomography, computer enhanced digital angiography, magnetic resonance imaging, ultrasonic-cardiography, positron emission tomography, single photon emission computerized tomography, percutaneous transluminal coronary angioplasty and other techniques, laser, artificial pacemaker, artificial heart etc. have greatly improved the capacity of diagnosis and therapy of cardiovascular diseases. Now the studies probe not only the levels of organ and cell, but also the levels of protein, nucleic acid and gene. The diagnosis of cardiovascular diseases is focussed on, besides the traditional "four diagnostic methods", i.e. inspection, palpation, percussion and auscultation, precise diagnosis with the help of various advanced medical equipments. As to the treatment, in addition to traditional drugs and surgical operations, new therapeutic methods such as gene therapy and interventional measures are also applied.
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