Cardiac pacing: role in diagnosis and treatment of disorders of cardiac rhythm and conduction

  • Albert L. Waldo
Chapter

Abstract

Cardiac pacing is the application of external electrical stimuli to the heart. Because cardiac tissue is excitable, external electrical stimuli delivered to the heart will evoke a propagated response provided the stimulus is of appropriate strength and duration and is delivered during a period when the cardiac tissue is capable of responding. External stimuli can be applied epicardially or endocardially to any of the cardiac chambers or, under special circumstances, to the His bundle or bundle branches via a suitable electrode placed temporarily or permanently. The heart also can be paced from electrodes placed in the correct position in the esophagus, or even from the anterior chest wall [1,2]. This chapter will deal with the application of cardiac pacing for the diagnosis and treatment of abnormalities of cardiac rhythm and conduction.

Keywords

Atrial Flutter Sinus Node Atrial Tachycardia Atrial Pace Cardiac Pace 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Zoll PM: The resuscitation of the heart in ventricular standstill by external electrical stimulation. N Engl J Med 247: 768–771, 1952.PubMedCrossRefGoogle Scholar
  2. 2.
    Gallagher JJ, Smith WM, Kerr CR, Kasell J, Cook L, Reiter M, Sterba R, Harte M: Esophageal pacing: a diagnostic and therapeutic tool. Circulation 65:336–341, 1982.PubMedCrossRefGoogle Scholar
  3. 3.
    Waldo AL, MacLean WAH: Diagnosis and Treatment of Cardiac Arrhythmias Following Open Heart Surgery. Emphasis on the Use of Atrial and Ventricular Epicardial Wire Electrodes. Futura Publ, Mt. Kisco, NY, 1980.Google Scholar
  4. 4.
    Maloney JD, Medina-Ravell V, Pieretti OH, Portillo B, Maduro C, Castellanos A, Berkovits B: Follow up assessment of dual-demand, dual chamber DVI-DVO pacing for automatic conversion, control and prevention of refractory paroxysmal upraventricular tachycardia. PACE 4:A-57, 1981 (abstract).Google Scholar
  5. 5.
    Waldo AL, Krongrad E, Kupersmith J, Levine OR, Bowman FO Jr, Hoffman BF: Ventricular paired-pacing to control rapid ventricular heart rate following open heart surgery: observations on ectopic automaticity: report of a case in a four-month-old patient. Circulation 53:176–181, 1976.PubMedGoogle Scholar
  6. 6.
    Cooper TB, MacLean WAH, Waldo AL: Overdrive pacing for supraventricular tachycardia. A review of theoretical implications and therapeutic techniques. PACE 1:196–221, 1978.PubMedGoogle Scholar
  7. 7.
    Waldo AL, Wells JL Jr, Cooper TB, MacLean WAH: Temporary cardiac pacing. Applications and techniques in the treatment of cardiac arrhythmias. Prog Cardiovsc Dis 23:451–473, 1981.CrossRefGoogle Scholar
  8. 8.
    Wellens HJJ: Value and limitations of programmed electrical stimulation of the heart in the study and treatment of tachycardias. Circulation 57:845–853, 1978.PubMedGoogle Scholar
  9. 9.
    Josephson ME, Seides SF: Clinical Cardiac Electrophysiology. Techniques and Interpretations. Lea and Febiger, Philadelphia, 1979.Google Scholar
  10. 10.
    Haft JI: Treatment of arrhythmias by intracardiac electrical stimulation. Prog Cardiovasc Dis 16:531–568, 1974.CrossRefGoogle Scholar
  11. 11.
    Wellens HJJ: Electrical Stimulation of the Heart in the Study and Treatment of Tachycardia. Univ Park Press, Baltimore, 1971.Google Scholar
  12. 12.
    MacLean WAH, Karp RB, Kouchoukos NT, James TN, Waldo AL: Uniformly successful interruption of atrial flutter with rapid atrial pacing in 100 patients. Circulation 54:II-167, 1976 (abstract).Google Scholar
  13. 13.
    Watson RM, Josephson ME: Atrial flutter. Electrophysiological substrates and modes of initiation and termination. Am J Cardiol 45:732–741, 1980.PubMedCrossRefGoogle Scholar
  14. 14.
    Puech P: L’Activité Électrique Auriculaire Normale et Pathologique. Masson and Cie. Paris 1956.Google Scholar
  15. 15.
    Amat-y-Leon F, Prakash D, Miller RH, Dhingra RC, Rosen K: A new approach for indirect recording of anterior left atrial activation in man. Am Heart J 93:408–410, 1977.PubMedCrossRefGoogle Scholar
  16. 16.
    Ogawa S, Dreifus LS, Kitchen JG III, Shenoy PN, Osmick MJ: Catheter recordings of Bachmann’s bundle activation from the right pulmonary artery: a new technique for mapping and study of supraventricular tachycardias. Am J Cardiol 41:1089–1096, 1978.PubMedCrossRefGoogle Scholar
  17. 17.
    Cooper TB, Hageman GR, James TN, Waldo AL: Neural effects on sinus rate and A-V conduction produced by electrical stimulation from a transvenous electrode catheter in the canine right pulmonary artery. Circ Res 46:48–57, 1980.PubMedGoogle Scholar
  18. 18.
    Hoffman BF, Cranefield PF: The physiologic basis of cardiac arrhythmias. Am J Med 37: 670–684, 1964.PubMedCrossRefGoogle Scholar
  19. 19.
    Cranefield PF, Wit AL, Hoffman BF: Genesis of cardiac arrhythmias. Circulation 47:190–201, 1973.PubMedGoogle Scholar
  20. 20.
    Wit AL, Fenoglio JJ Jr, Wagner BM, Bassett AL: Electrophysiological properties in the cardiac muscle in the anterior mitral valve leaflet and the adjacent atrium in the dog. Possible implications for the genesis of atrial dysrhythmias. Circ Res 32:731–745, 1973.PubMedGoogle Scholar
  21. 21.
    Bassett AL, Fenoglio JJ Jr, Wit AL, Myerburg RJ, Gelband H: Electrophysiologic and ultrastructural characteristics of the canine tricuspid valve. Am J Physiol 230:1366–1373, 1976.PubMedGoogle Scholar
  22. 22.
    Wit AL, Cranefield PF: Triggered and automatic activity in the canine coronary sinus. Circ Res 41:435–445, 1977.Google Scholar
  23. 23.
    Wit AL, Fenoglio JJ Jr, Hordof AJ, Reemtsma K: Ultrastructure and transmembrane potentials of cardiac muscle in the human anterior mitral valve leaflet. Circulation 59: 1284–1292, 1979.PubMedGoogle Scholar
  24. 24.
    Vasalle M: The relationship among cardiac pacemakers. Overdrive suppression. Circ Res 41:269–277, 1977.Google Scholar
  25. 25.
    Barold SS, Coumel P: Mechanisms of the atrioventricular junctional tachycardia. Role of reentry and concealed accessory bypass tracts. Am J Cardiol 39:97–106, 1977.PubMedCrossRefGoogle Scholar
  26. 26.
    Waldo AL, MacLean WAH, Karp RB, Kouchoukos NT, James TN: Entrainment and interruption of atrial flutter with atrial pacing: studies in man following open heart surgery. Circulation 56:737–745, 1977.PubMedGoogle Scholar
  27. 27.
    MacLean WAH, Plumb VJ, Waldo AL: Transient entrainment and interruption of ventricular tachycardia. PACE 4:358–366, 1981.PubMedGoogle Scholar
  28. 28.
    Plumb VJ, MacLean WAH, Cooper TB, James TN, Waldo AL: Atrial events during entrainment and interruption of atrial flutter by rapid atrial pacing. Circulation 60:11–64, 1979 (abstract).Google Scholar
  29. 29.
    Plumb VJ, James TN, Waldo AL: Evidence that atrial flutter is due to a circus movement with an excitable gap. Circulation 62:III-46, 1980 (abstract).Google Scholar
  30. 30.
    Waldo AL, Plumb VJ, Arciniegas JG, James TN: Transient entrainment and interruption of A-V bypass pathway type paroxysmal atrial tachycardia. A model for understanding and identifying reentrant arrhythmias. Circulation 67:73–83, 1983.PubMedCrossRefGoogle Scholar
  31. 31.
    Henthorn RW, Plumb VJ, Arciniegas JG, Waldo AL: Entrainment of ‘ectopic atrial tachycardia’: evidence for re-entry. Am J Cardiol 49:920, 1982 (abstract).CrossRefGoogle Scholar
  32. 32.
    Allessie MA, Bonke FIM, Schopman FJG: Circus movement in rabbit atrial muscle as a mechanism of tachycardia. III. The ‘leading circle’ concept: a new model of circus movement in cardiac tissue without the involvement of an anatomical obstacle. Circ Res 41:9–18, 1977.PubMedGoogle Scholar
  33. 33.
    Rosen MR, Reder RF: Does triggered activity have a role in the genesis of cardiac arrhythmias? Ann Intern Med 94: 794–801, 1981.PubMedGoogle Scholar
  34. 34.
    Cranefield PF: The Conduction of the Cardiac Impulse. Futura Publ, Mt. Kisco, NY, 1975.Google Scholar
  35. 35.
    Cranefield PF: Action potentials, afterpotentials, and arrhythmias. Circ Res 41:415–423, 1977.PubMedGoogle Scholar
  36. 36.
    Wit AL, Cranefield PF: Triggered activity in cardiac muscle fibers of the simian mitral valve. Circ Res 38:85–89, 1976.PubMedGoogle Scholar
  37. 37.
    Wit AL, Cranefield PF, Gadsby DC: Electrogenic sodium extrusion can stop triggered activity in the canine coronary sinus. Circ Res 49:1029–1042, 1981.PubMedGoogle Scholar
  38. 38.
    Rosen KM, Sinno MZ, Gunnar RM, Ruhimtoola SH: Failure of rapid atrial pacing in the conversion of atrial flutter. Am J Cardiol 29:524–528, 1972.PubMedCrossRefGoogle Scholar
  39. 39.
    Inoue H, Matsuo H, Takayunagi K, Murao S: Clinical and experimental studies of the effects of atrial extrastimulation and rapid pacing on atrial flutter cycle. Evidence for macroreentry with an excitable gap. Am J Cardiol 48:623–631, 1981.PubMedCrossRefGoogle Scholar
  40. 40.
    Fisher JD, Kim SG, Furman S, Matos JA: Role of implantable pacemakers in control of recurrent ventricular tachycardia. Am J Cardiol 49:194–206, 1982.PubMedCrossRefGoogle Scholar
  41. 41.
    Wellens HJJ, Brugada P, Vanagt EJDM, Ross DL, Barr FW: New studies with triggered automaticity. In: Harrison DC (ed) Cardiac Arrhythmias. A Decade of Progress. GK Hall Med Publ, Boston, 1981, pp 601–612.Google Scholar
  42. 42.
    Zipes DP: A defense of triggered automaticity. In Harrison DC (ed) Cardiac Arrhythmias. A Decade of Progress. GK Hall Med Publ, Boston, 1981, pp 591–599.Google Scholar
  43. 43.
    Wells JL Jr, MacLean WAH, James TN, Waldo AL: Characterization of atrial flutter. Studies in man after open heart surgery using fixed atrial electrodes. Circulation 60:665–673, 1979.PubMedGoogle Scholar
  44. 44.
    Waldo AL, Wells JL Jr, Plumb VJ, Cooper TB, MacLean WAH: Characterization of atrial flutter - studies in patients following open heart surgery. In: Narula OS (ed) Cardiac Arrhythmias. Mechanism, Diagnosis, Management. Williams and Wilkins, Baltimore, 1979, pp 256–271.Google Scholar
  45. 45.
    Waldo AL, MacLean WAH, Karp RB, Kouchoukos NT, James TN: Continuous rapid atrial pacing to control recurrent or sustained supraventricular tachycardias following open heart surgery. Circulation 54:245–250, 1976.PubMedGoogle Scholar
  46. 46.
    Langendorf R, Pick A: Observations on the clinical use of paired electrical stimulation of the heart. Bull NY Acad Med 41:535–540, 1965.Google Scholar
  47. 47.
    Lister JW, Damato AN, Kosowsky BD, Lau SH, Stein E: The hemodynamic effect of slowing the heart rate by paired or coupled stimulation of the atria. Am Heart J 73:362–368, 1967.PubMedCrossRefGoogle Scholar
  48. 48.
    Krikler DM, Curry PVL: Torsade de pointes, an atypical ventricular tachycardia. Br Heart J 38:117–120, 1976.PubMedCrossRefGoogle Scholar
  49. 49.
    Fisher JD, Mehra R, Furman S: Termination of ventricular tachycardia with bursts of ventricular pacing. Am J Cardiol 41: 94–102, 1978.PubMedCrossRefGoogle Scholar
  50. 50.
    Wellens HJJ, Duren DR, Lie KI: Observations on mechanisms of ventricular tachycardia in man. Circulation 54: 237–244, 1976.PubMedGoogle Scholar
  51. 51.
    MacLean WAH, Cooper TB, James TN, Waldo AL: Entrainment and interruption of ventricular tachycardia by rapid atrial pacing in man. Clin Res 27:771 A, 1979 (abstract).Google Scholar
  52. 52.
    Ferrer MI: The Sick Sinus Syndrome. Futura Publ, Mt. Kisco, NY, 1974.Google Scholar
  53. 53.
    Narula OS: Atrioventricular block. In: Narula OS (ed) Cardiac Arrhythmias. Electrophysiology, Diagnosis and Management, Williams and Wilkins, Baltimore, 1979, pp 85–110.Google Scholar
  54. 54.
    Langendorf R, Pick A: Atrioventricular block, Type II (Mobitz): its nature and clinical significance. Circulation 38: 819–821, 1968.PubMedGoogle Scholar
  55. 55.
    Dhingra RC, Wyndham C, Amat-y-Leon F, Denes P, Wu D, Sridhar S, Bustin AG, Rosen KM: Incidence and site of atrioventricular block in patients with chronic bifascicular block. Circulation 59:238–246, 1979.PubMedGoogle Scholar
  56. 56.
    Scheinman MM, Peters RW, Modin G, Brennan M, Mies C, O’Young J: Prognostic value of infranodal conduction time in patients with chronic bundle branch block. Circulation 56:240–244, 1977.PubMedGoogle Scholar
  57. 57.
    Kulbertus HE, de Leval-Rutten F, Du Bois M, Petit JM: Prognostic significance of left anterior hemiblock with right bundle branch block in mass screening. Am J Cardiol 41:385, 1978 (abstract).CrossRefGoogle Scholar
  58. 58.
    McAnulty JH, Rahimtoola SH, Murphy ES, Kauffman S, Ritzmann LW, Kanarek P, DeMots H: A prospective study of sudden death ‘high-risk’ bundle-branch block. N Engl J Med 299:209–215, 1978.PubMedCrossRefGoogle Scholar
  59. 59.
    Dhingra RC, Wyndham C, Bauernfeind R, Swiryn S, Deedwania PC, Smith T, Denes P, Rosen KM: Significance of block distal to the His bundle induced by atrial pacing in patients with chronic bifascicular block. Circulation 60: 1455–1464, 1979.PubMedGoogle Scholar
  60. 60.
    Narula OS: Intraventricular conduction defects: current concepts and clinical significance. In: Narula OS (ed) Cardiac Arrhythmias. Electrophysiology, Diagnosis, and Management, Williams and Wilkins, Baltimore, 1979, pp 114–139.Google Scholar
  61. 61.
    Kupersmith J, Krongrad E, Waldo AL: Conduction intervals and conduction velocity in the human cardiac conduction system: studies during openheart surgery. Circulation 47:776–785, 1973.PubMedGoogle Scholar
  62. 62.
    Scheinman M, Peters R, Sauve MJ, Desai J, Cogan J, Wohl B: Graded influence of the H-V interval on the incidence of spontaneous infranodal block. Circulation 64:IV-144, 1981 (abstract).Google Scholar
  63. 63.
    Denes P, Dhingra RC, Wu D, Chuquimia R, Amat-y-Leon F, Wyndham C, Rosen KM: H-V interval in patients with bifascicular (right bundle branch block and left anterior hemiblock). Clinical, electrocardiographic, and electrophysiologic correlations. Am J Cardiol 35:23–29, 1975.PubMedCrossRefGoogle Scholar
  64. 64.
    Dhingra RC, Denes P, Wu D, Chuquimia R, Amat-y-Leon F, Wyndham C, Rosen KM: Chronic right bundle branch block and left posterior hemiblock. Clinical, electrophysiologic and prognostic observations. Am J Cardiol 36:867–872, 1975.PubMedCrossRefGoogle Scholar
  65. 65.
    Dhingra RC, Denes P, Wu D, Wyndham CR, Amat-y-Leon F, Towne WD, Rosen KM: Prospective observations in patients with chronic bundle branch block and marked H-V prolongation. Circulation 53:600–609, 1976.PubMedGoogle Scholar
  66. 66.
    Altschuler H, Fisher JD, Furman S: Significance of isolated H-V interval prolongation in symptomatic patients without documented heart block. Am Heart J 97:19–26, 1979.PubMedCrossRefGoogle Scholar
  67. 67.
    Dhingra RC, Palileo E, Strasberg B, Swiryn S, Bauernfein RA, Wyndham CRC, Rosen KM: Significance of the HV interval in 517 patients with chronic bifascicular block. Circulation 64:1265–1271, 1981.PubMedCrossRefGoogle Scholar
  68. 68.
    Atkins JM, Leshen SJ, Blomqvist G, Mullins CB: Ventricular conduction blocks and sudden death in acute myocardial infarction: potential indications for pacing. N Engl J Med 288:281–284, 1973.PubMedCrossRefGoogle Scholar
  69. 69.
    Hindman MC, Wagner GS, JaRo M, Atkins JM, Scheinmann MM, DeSanctis RW, Hutter AH Jr, Yeatman L, Rubenfire M, Pujura C, Rubin M, Morris JJ: The clinical significance of bundle branch block complicating acute myocardial infarction. 2. Indications for temporary and permanent pacemaker insertion. Circulation 58:689–699, 1978.PubMedGoogle Scholar
  70. 70.
    Lie KI, Durrer D: Conduction disturbances in acute myocardial infarction. In: Narula OS (ed) Cardiac Arrhythmias. Electrophysiology, Diagnosis, and Management, Williams and Wilkins, Baltimore, 1979, pp 140–163.Google Scholar
  71. 71.
    Waldo AL, Kaiser GA, Bowman FO Jr, Malm JR: Etiology of prolongation of the P-R interval in patients with an endocardial cushion defect: further observations on internodal conduction and the polarity of retrograde P wave. Circulation 48:19–27, 1973.PubMedGoogle Scholar
  72. 72.
    Mandel W, Hayakawa H., Danzig R, Marcus HS: Evaluation of sino-atrial node function in man by overdrive suppression. Circulation 44:59–66, 1971.PubMedGoogle Scholar
  73. 73.
    Mandel WJ, Hayakawa H, Allen HN, Danzig R, Kermaier AI: Assessment of sinus node function in patients with the sick sinus syndrome. Circulation 46:761–769, 1972.PubMedGoogle Scholar
  74. 74.
    Narula OS, Samet P, Javier, RP: Significance of sinus-node recovery time. Circulation 45:140–158, 1972.PubMedGoogle Scholar
  75. 75.
    Strauss HC, Bigger JT Jr, Saroff AL, Giardina EV: Electrophysiologic evaluation of sinus node function in patients with sinus node dysfunction. Circulation 53:763–776, 1976.PubMedGoogle Scholar
  76. 76.
    Jordan J, Yamaguchi I, Mandel WJ, McCullen AE: Comparative effects of overdrive on sinus and subsidiary pacemaker function. Am Heart J 93:367–374, 1977.PubMedCrossRefGoogle Scholar
  77. 77.
    Benditt DG, Strauss HC, Scheinman MM, Behard VF, Wallace AG: Analysis of secondary pauses following termination of rapid atrial pacing in man. Circulation 54:436–441, 1976.PubMedGoogle Scholar
  78. 78.
    Breithardt G, Seipel L, Loogen E: Sinus node recovery time in calculated sinoatrial conduction in normal subjects and patients with sinus node dysfunction. Circulation 56:43–50, 1977.PubMedGoogle Scholar
  79. 79.
    Miller HC, Strauss HC: Measurement of sinoatrial conduction time by premature atrial stimulation in the rabit. Circ Res 35:935–947, 1974.PubMedGoogle Scholar
  80. 80.
    Strauss HC, Saroff AL, Bigger JT Jr, Giardina EV: Premature atrial stimulation as a key to the understanding of sinoatrial conduction in man. Presentation of data and critical review of the literature. Circulation 47:86–93, 1973.PubMedGoogle Scholar
  81. 81.
    Narula OS, Shantha N, Vasquez M, Towne WD, Linhart JW: A new method for measurement of sinoatrial conduction time. Circulation 58:706–714, 1978.PubMedGoogle Scholar
  82. 82.
    Jose AD, Collison D: The normal range in determinants of the intrinsic heart rate in man. Cardiovasc Res 4:160–167, 1970.PubMedCrossRefGoogle Scholar
  83. 83.
    Cramer M, Siegal M, Bigger JT Jr, Hoffman BF: Characteristics of extracellular potentials recorded from the sinoatrial pacemaker of the rabbit. Circ Res 41:292–300, 1977.PubMedGoogle Scholar
  84. 84.
    Hariman J, Krongrad H, Boxer RA, Weiss MB, Steeg CN, Hoffman BF: Method for recording electrical activity of the sinoatrial node and automatic atrial foci during cardiac catheterization in human subjects. Am J Cardiol 45:775–781, 1980.PubMedCrossRefGoogle Scholar
  85. 85.
    Reiffel JA, Gang E, Gliklich J, Weiss MB, Davis JC, Patton JN, Bigger JT Jr: The human sinus node electrogram: a transvenous catheter technique and a comparison of directly measured and indirectly estimated sinoatrial conduction time in adults. Circulation 62:1324–1334, 1980.PubMedGoogle Scholar
  86. 86.
    Strauss HC, Bigger JT Jr: Electrophysiological properties of the rabbit’s sinatrial perinodal fibers. Circ Res 37:490–506, 1972.Google Scholar
  87. 87.
    Lister JW, Stein E, Kosowsky BD, Lau SH, Damato AN: Atrioventricular conduction in man. Effect of rate, exercise, isoproterenol, and atropine on the P-R interval. Am J Cardiol 16:516–523, 1965.PubMedCrossRefGoogle Scholar
  88. 88.
    Waldo AL, Cooper TB, MacLean WAH: Editorial: need for additional criteria for the diagnosis of sinus node reentrant tachycardias. J Electrocardiol 10:103–104, 1977.PubMedCrossRefGoogle Scholar
  89. 89.
    Myerburg RJ, Sung RJ, Gerstenblith G, Mallon SM, Castellanos A, Lazzara R: Ventricular ectopic activity after premature atrial beats in acute myocardial infarction. Br Heart J 39:1033–1037, 1977.PubMedCrossRefGoogle Scholar
  90. 90.
    Wellens, HJJ, Bar FW, Farre J, Ross DL, Weiner I, Vanagt EJ: Initiation and termination of ventricular tachycardia by supraventricular stimuli. Incidence and electrophysiologic determinants as observed during programmed stimulation of the heart. Am J Cardiol 46:576–582, 1980.PubMedCrossRefGoogle Scholar
  91. 91.
    Josephson ME: Paroxysmal supraventricular tachycardia. An electrophysiological approach. Am J Cardiol 41:1123–1126, 1978.PubMedCrossRefGoogle Scholar
  92. 92.
    Gallagher JJ, Smith WM, Kasell J, Smith WM, Grant AO, Benson DW Jr: Use of the esophageal lead in the diagnosis of mechanisms of reciprocating supraventricular tachycardia. PACE 3:440–451, 1980.PubMedGoogle Scholar
  93. 93.
    Josephson ME, Horowitz LN: Electrophysiologic approach to therapy of recurrent sustained ventricular tachycardia. Am J Cardiol 43:631–642, 1979.PubMedCrossRefGoogle Scholar
  94. 94.
    Sherf L, Neufeld HN: Preexcitation Syndrome. Facts and Theories. Yorke Med Books, New York, 1978.Google Scholar
  95. 95.
    Gallagher JJ, Sealy WC, Pritchett ELC, Kasell J, Wallace AG: Wolff-Parkinson-White syndrome: experience with 83 patients. In: Kelly DT (ed) Advances in the Management of Arrhythmias. Telectronics, Pty, Ltd, New South Wales, Australia, 1978, pp 47–72.Google Scholar
  96. 96.
    Wellens HJJ, Durrer D: Wolff-Parkinson-White syndrome and atrial fibrillation. Relations between refractory period, accessory pathway, and ventricular rate during atrial fibrillation. Am J Cardiol 34:777–782, 1974.PubMedCrossRefGoogle Scholar
  97. 97.
    Horowitz LN, Josephson ME, Kastor J A: Intracardiac electrophysiologic studies as a method for the optimization of drug therapy in chronic ventricular arrhythmia. Prog Cardiovasc Dis 23:81–98, 1980.PubMedCrossRefGoogle Scholar
  98. 98.
    Fisher JD, Cohen HL, Mehra R, Altschuler H, Escher DJW, Furman S: Cardiac pacing and pacemakers. II. Serial electrophysiologic - pharmacologic testing for control of recurrent tachyarrhythmias. Am Heart J 93:658–668, 1977.PubMedCrossRefGoogle Scholar
  99. 99.
    Ruskin JN, DiMarco JP, Garan H: Out-of-hospital cardiac arrest. Electrophysiologic observations and selection of long-term antiarrhythmic therapy. N Engl J Med 303: 607–613, 1980.PubMedCrossRefGoogle Scholar

Copyright information

© Martinus Nijhoff Publishers, Boston, The Hague, Dordrecht, Lancaster 1983

Authors and Affiliations

  • Albert L. Waldo

There are no affiliations available

Personalised recommendations