Charles W. Harris

Percutaneous technic for cardiac pacing with a platinum-tipped electrode catheter☆

Abstract We have reported a rapid and simple percutaneous technic for initiating intracardiac pacing at the bedside utilizing a small platinum-tipped wire electrode catheter. The method is valuable and potentially life-saving, both pro-phylactically and therapeutically, in the management of Stokes-Adams disease, complete heart block and asystole, particularly when drugs prove ineffective.

Electrocardiographic changes during exposure to high altitude

Abstract Serial electrocardiograms were obtained in 22 sea level residents and 20 Denver residents while at altitudes of 11,400 or 14,110 feet for four to five weeks. Significant QRS changes were noted in the groups at each high altitude; however, only minimal changes occurred in the Denver subjects at 11,400 feet. Pertinent findings include transient increases in heart rate, decreases in QRS amplitude, and T wave inversion; rightward and posterior shifts in QRS axis were progressive and prolonged. The variables of daily controlled exercise, depth of inspiration, and speed of ascent did not significantly influence the electrocardiographic findings. It is suggested that changes in QRS amplitude and T waves at altitude are transient effects of cardiac hypoxia, while prolonged shifts of the QRS axis may represent early stages of myocardial hypertrophy and are secondary to changes in pulmonary perfusion rather than ventilation.

Hydrogen-sensitive, platinum-tipped electrode in the diagnosis of left to right shunts: Practical application☆

Abstract A new technic, utilizing a hydrogen-sensitive, platinum-tipped wire electrode introduced percutaneously via a No. 18 Cournand needle into the brachial vein and flow-directed into the right heart chambers and pulmonary artery, has greatly simplified the detection of left to right intracardiac shunts. The position of the electrode is identified by intracavitary electrocardiographic monitoring. Electrical potential, created by contact of inhaled hydrogen with the platinum tip, produces characteristic electrocardiographic deflections when left to right shunts are present. Two hundred and four catheterizations in 182 patients screened for possible left to right shunts yielded 86 positive, 115 negative and 3 equivocal shunt curves. Fifty-three instances have been confirmed by conventional cardiac catheterization technics or surgery, or by both. No definite false positive curves were obtained other than from the easily identified pulmonary wedge position. In 5 patients false negative curves were obtained from the proper chamber; however, in each instance positive curves were recorded from one chamber distally. This technic can be performed as an outpatient procedure in 15 to 30 minutes without discomfort except for venipuncture. Minor complications observed were brief supraventricular arrhythmia (3), multiple extrasystoles (2), transient difficulty in electrode dislodgment (2), and intracavitary knotting (2). No major complications have occurred. Caution is expressed regarding proper grounding of all electrical equipment to prevent electrically induced ventricular fibrillation. The potential hazard of a knot in the wire electrode embracing a papillary muscle or chorda tendinea suggests the need of ready access to an experienced cardiac surgeon. The procedure presents a simple, reliable and reasonably safe method for determing left to right shunts, both preoperatively and postoperatively, and often obviates the need for major catheterization.

Postoperative use of the hydrogen-sensitive, platinum-tipped electrode: Detection of residual left to right shunts☆

Abstract Seventy-seven patients submitted for surgical correction of left to right cardiac shunts were studied postoperatively by the hydrogen-sensitive, platinum-tipped electrode technic. The series was composed of atrial septal defects (51 patients), ventricular septal defects (20 patients) and a miscellaneous group (6 patients). Positive hydrogen electrode studies indicating persistent postoperative shunting were observed in 5 atrial septal defects (10%), 9 ventricular defects (45%) and 3 of the miscellaneous group. In this series, surgical closure of atrial septal defects was quite successful (90%), the results being better for secundum (94%) than for primum defects (60%). Operative closure of ventricular septal defects was less successful (55%) for either uncomplicated defects (60%) or those complicated by pulmonic stenosis (53%). In each of 8 patients results obtained from electrode studies were confirmed by catheterization or by further surgery. Twentytwo patients whose atrial defects were considered closed retained the split of the pulmonic second sound; therefore, this sign does not necessarily indicate a persistent shunt. It is concluded that the hydrogen-sensitive, platinum-tipped electrode technic offers a simple, sensitive and accurate method for evaluating operative success in the repair of various left to right cardiac shunts.

Clinical Ecology and the Open Mind

Excerpt To the Editor:Kahn and Letz (1) properly think that the practice of clinical ecology should be validated by controlled, reproducible clinical trials. It is true, as they say, that clinical ...

Electrocardiographic and radiographic heart changes in women at high altitude

Abstract Electrocardiographic, vectorcardiographic and radiographic cardiac changes are described in 8 young women during 10 weeks of residence at high altitude (14,110ft.). The changes in electrical activity were similar in type to those reported in natives of high altitude and also to those in male subjects previously observed at this altitude. Prominent findings at altitude included increased heart rate, a rightward shift in ÂQRS and increased spatial vector magnitude of terminal QRS force (S vector). Minor changes were observed in P wave contour, T wave voltage and contour and in QRS amplitude. A slight reduction in frontal radiographic heart size was also noted; however, lateral views suggested that the over-all size of the heart was probably unchanged during the stay at altitude. Some comments on the probable etiology and significance of the observed changes are given.

The Practical Application of the Hydrogen Sensitive Platinum Tipped Electrode in the Diagnosis of Left-to-Right Shunts.

Excerpt A new technique, utilizing a hydrogen-sensitive, platinum-tipped wire electrode introduced percutaneously by a no. 18 Cournand needle into the brachial vein and flow directed into the right...