PubMed · 14775779
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G A C BOSCH. 1950-09-02. [Double auricular action].. https://pubmed.ncbi.nlm.nih.gov/14775779/
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The goals of electrocardiographic (ECG) monitoring in hospital settings have expanded from simple heart rate and basic rhythm determination to the diagnosis of complex arrhythmias, myocardial ischemia, and prolonged QT interval. Whereas computerized arrhythmia analysis is automatic in cardiac monitoring systems, computerized ST-segment ischemia analysis is available only in newer-generation monitors, and computerized QT-interval monitoring is currently unavailable. Even in hospitals with ST-monitoring capability, ischemia monitoring is vastly underutilized by healthcare professionals. Moreover, because no computerized analysis is available for QT monitoring, healthcare professionals must determine when it is appropriate to manually measure QT intervals (eg, when a patient is started on a potentially proarrhythmic drug). The purpose of the present review is to provide 'best practices' for hospital ECG monitoring. Randomized clinical trials in this area are almost nonexistent; therefore, expert opinions are based upon clinical experience and related research in the field of electrocardiography. This consensus document encompasses all areas of hospital cardiac monitoring in both children and adults. The emphasis is on information clinicians need to know to monitor patients safely and effectively. Recommendations are made with regard to indications, timeframes, and strategies to improve the diagnostic accuracy of cardiac arrhythmia, ischemia, and QT-interval monitoring. Currently available ECG lead systems are described, and recommendations related to staffing, training, and methods to improve quality are provided.
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Controlling cardiac chaos is often achieved by applying a large damaging electric shock-defibrillation. It removes all waves, without differentiating reentries and normal waves, anatomical and functional reentries. Anatomical reentries can be removed by anti-tachycardia pacing (ATP) as well. But ATP requires the knowledge of the position of the reentry, and an access to it with an invasive stimulating electrode. We show that the physics of electric field distribution between cardiac cells permits one to deliver an electric pulse exactly to the core of an anatomical reentry, without knowing its position and even to locations where access with a stimulating electrode is not possible. The energy needed is two orders of magnitude less than defibrillation energy. The results are insensitive to both a detailed ionic model and to the geometry of the fibers.