A complex binomial bandpass filter is suggested for the analysis of ECG and MCG signals. Theoreti... more A complex binomial bandpass filter is suggested for the analysis of ECG and MCG signals. Theoretical background and details of the appropriate design of these filters are given. Application of these digital filters on ECG/MCG signals provide bandpass signals. Envelope and phase of these signals are used for analysing high frequency components in cardiac signals. Phase variance changes are used to select time intervals dominated by cardiac activity. Mean and variance of the envelope characterize the regularity of the depolarisation process. Two parameters derived from these quantities are used to separate MCGs of patients suffering from ventricular arrhythmia from MCGs of healthy persons
Herzschrittmachertherapie und Elektrophysiologie, 2000
ABSTRACT The spread of electrical endo- and epicardial activation is projected also to body surfa... more ABSTRACT The spread of electrical endo- and epicardial activation is projected also to body surface and can be deducted from various numbers of recording points at the front or the back of the thorax. The resulting data are visualized in a body surface map (BSM). To characterize this activation, the amplitudes are measured and then evaluated according to the origin, the position of the extrema, and the zero line between them. To minimize the BSM data during the activation cycle, the area underneath the QRS complex and/or the ST-T wave may be calculated and plotted as an iso-area BSM. Similarities between the various BMSs are evaluated either by visual comparison or by means of correlation algorithms. The results exceeded the precision of standard ECG recordings in measuring de- and repolarization. Comparison between a succession of paced maps resulted in the precise localization of arrhythmogenic sources. Due to the inhomogeneities of the human thorax direct measurement of the position of an electric source, e.g., the focus of ventricular tachycardia or extrasystole, has not yet been accomplished. Magnetocardiographic mapping, a novel method to record the heart‘s magnetic field, however, allows for direct measurement of the arrhythmic origin since this method is not sensitive to these inhomogeneities. Various examples of the clinical application of BSM have been described in this paper and their results discussed. Die Ausbreitung der elektrischen endo- und epikardialen Aktivierung ist auch auf die Körperoberfläche projiziert und kann dort von einer Vielzahl von dosalen und ventralen Ableitungspunkten als Körperoberflächen-Mapping (BSM) registriert werden. Um diese Aktivierung zu diagnostischen Zwecken zu charakterisieren, werden die früheste Erregung, die Extremata und die dazwischen liegende Nulllinie verwendet. Um den Datenumfang zu minimieren, wird die Fläche unter dem QRS bestimmt und ein Iso-Area-BSM gebildet. Diese Maps werden durch visuellen Vergleich oder durch die Berechnung der Korrelation miteinander verglichen. Abnorme Änderungen der De- und Repolarisation werden damit ebenso ermittelt wie die Lokalisation von Arrythmie-Herden. Letzteres erfolgt im Vergleich zu zuvor durch Stimulation ermittelten Map-Konfigurationen. Aufgrund der Inhomogenität des Thorax ist eine direkte Messung der elektrischen Quelle nicht möglich. Die Magnetokardiographie jedoch, mit der das durch die elektrische Aktivierung des Herzens erzeugte magnetische Feld gemessen wird, erlaubt die Messung des Ursprungsortes, da diese Methode nicht wesentlich von diesen Inhomogenitäten abhängig ist. Verschiedene klinische Anwendungsbeispiele werden in dieser Arbeit referiert und diskutiert.
Bandlimited frequency components are used to estimate the variability of QRS-shape and heart rate... more Bandlimited frequency components are used to estimate the variability of QRS-shape and heart rate. Utilising complex binomial filters, the applied signal processing method allows to analyse envelope and phase (current frequency) of the bandpass signal independently of each other. A beat-to-beat analysis of envelope and current frequency of the entire QRS interval gives an estimate of the QRS variability. A short term heart rate variability is calculated in terms of the heart frequency deviation of the continuously filtered cardiac signal which is determined by the bandwidth of the envelope spectrum in the vicinity of the mean beat frequency. Mean-to-standard deviation ratio of the envelope and current frequency and the heart frequency deviation are combined to a parameter that separate cardiac signals of patients suffering from ventricular arrhythmia from cardiac signals of healthy persons
In 20 infarct patients, whose age varies from 43 to 78 years (m 59.6), continuous hemodynamic mea... more In 20 infarct patients, whose age varies from 43 to 78 years (m 59.6), continuous hemodynamic measurements were made to determine the cardiovascular effects of propranolol without and during a simultaneous infusion treatment with nitroglycerin. In cases of compensated ventricular function and pulmonary wedged pressures of 15 mm Hg or less (N = 10), a mean intravenous propranolol dose of 6.1 +/- 1.3 mg led to a significant reduction of the LVSWI and a simultaneous increase of the PCP by 31% of the control value (P less than or equal to 0.005). A simultaneously performed infusion treatment with nitroglycerin at a mean dose of 3.0 +/- 1.6 mg/h resulted in totally cutting off the propranolol-induced PCP increase, whereas a decrease of the heart rate and the LVSWI due to a beta-receptor-blockade remained completely unchanged. In the case of pre-existing congestion insufficiency of the left ventricle (N = 10) and of a pulmonary wedged pressure of above 15 mm Hg, the administration of a mean dose of propranolol of 5.8 +/- 1.1 mg for protection of the myocardium resulted in a partly disquieting decrease of the volume of cardiac output (P less than or equal to 0.005) which was 28% of the control value for the CI an 12% for the SVI. Correspondingly the left ventricular stroke work decreased to 18%. Nitroglycerin has a reducing influence on these changes, but not down to the initial level. In cases of sufficient ventricular function, propranolol has a favorable influence on the myocardial O2-metabolism via its depressor effect on heart rate and contractility. By means of nitroglycerin, an increase of the pulmonary wedged pressure occurring under this condition can be inhibited. However, in the case of a pre-existing congestion insufficiency, propranolol can lead to a partly disquieting depression of the circulation, which, apart from the hemodynamic risks, makes a rather unfavorable influence on the myocardial O2-metabolism seem likely.
A controlled trial in 149 patients admitted to a district hospital with probable myocardial infar... more A controlled trial in 149 patients admitted to a district hospital with probable myocardial infarction tested the effect of 30 units of anisoylated plasminogen streptokinase activator complex (APSAC) on indices of infarct size. Patients were grouped prospectively according to whether they entered the trial within two and a half hours (early entry) or between two and a half and four hours (late entry) after onset ofthe symptoms. Sixty seven of 73 patients in the control group showed increased plasma activity of myocardial creatine kinase isoenzyme that was diagnostic of infarction compared with only 60 of 76 who received APSAC. The difference was significant overall but occurred predominantly in the early entry group. The patients who received APSAC had more early ventricular arrhythmias, compatible with reperfusion, and showed greater preservation of R waves during admission to hospital. Unwanted effects were generally minor and more common in the actively managed group than the control group (26% v 3%). After nine to 12 months offollow up 12 patients in the control group had died compared with seven in the actively managed group.
ZUSAMMENFASSUNG Hintergrund: Telemonitoring kann die Versorgung, die Lebensqualität und die Progn... more ZUSAMMENFASSUNG Hintergrund: Telemonitoring kann die Versorgung, die Lebensqualität und die Prognose von Patienten mit chronischen Erkrankungen verbessern. Die Übersichtsarbeit fasst den Stand der Versorgungsforschung zum Telemonitoring zusammen und legt einen Schwerpunkt auf Patienten mit chronischer Herzinsuffizienz. Methode: Selektive Literaturrecherche über die Datenbank Medline mit Fokus auf randomisierte kontrollierte Studien (6/2001 bis 5/2008). Ergebnisse: Trotz der insgesamt geringen Datenlage zum Monitoring von Vitalsignalen zeigt sich insgesamt eine Evidenz bezüglich der Verbesserung klinischer Endpunkte, insbesondere der Sterblichkeit. Im Hinblick auf die Verbesserung patientenbezogener Endpunkte, zum Beispiel der Lebensqualität, steht der Nachweis noch aus. Schlussfolgerung: Trotz der Hinweise für die Wirksamkeit von Telemonitoring fehlt es an Evidenz, welches Modell der Versorgung über Telemonitoring, das heißt Vitalparametermonitoring versus strukturiertes Telefonmonitoring, die besten Ergebnisse erzielt. Kritisch ist anzuführen, dass die isolierten Wirkmechanismen des häuslichen Telemonitorings noch nicht vergleichend in ihrer Effektivität geprüft wurden.
Nineteen patients in the acute stage of transmural myocardial infarction were given 20 mg nifedip... more Nineteen patients in the acute stage of transmural myocardial infarction were given 20 mg nifedipine orally under haemodynamic control. Two groups were differentiated according to the original left ventricular filling pressure: group 1 pressure less than or equal to 15 mm Hg (n1 = 8), group 2 pressure > 15 mm Hg (n2 = 11). In both groups a significant drop in peripheral resistance and thus arterial mean pressure was found 1-2 hours after ingestion of nifedipine. in the compensated patients in group 1 it led to lowering of the left ventricular stroke-work index with virtually unchanged heart rate and constant cardiac index. The lower initial values for stroke-work index in the decompensated group 2 were not influenced by nifedipine. In the patients of group 2 a small but yet significant lowering of the left ventricular filling pressure was obtained with original values of 22.6 mm Hg on average. Thus the use of nifedipine in the acute phase of myocardial infarction leads to a more economical cardiac action in compensated patients. In decompensated cases the results do not deteriorate, and the tendency to reduction of left ventricular filling pressure may even result in a recompensation of the left ventricle.
The acute hemodynamic effects of the Ca-antagonist Diltiazem were measured in the course of diagn... more The acute hemodynamic effects of the Ca-antagonist Diltiazem were measured in the course of diagnostic cardiac catheter examinations in 10 patients with coronary heart disease. After initial step-wise ergometric stress, Diltiazem (D) was applied intravenously for 5 min at a dose of 0.3 mg/kg. The effects on right and left ventricular performance as well as on arterial pressure and heart rate were registered 1, 3, 5, 10 and 15 min after termination of the infusion. Then, a second period of ergometric exertion under identical stress conditions was performed. The results under resting conditions show that D effects a significant increase in left ventricular filling pressure (p greater than 0.005), which, however, only lasts a few minutes. After D, the systolic and mean arterial pressure decreases significantly (p greater than 0.001); there is no reflex-induced increase in the heart rate, which on the contrary is significantly lower (p greater than 0.005) 15 min after termination of the infusion than the initial value. The stroke volume index increases from 40 to maximally 48 ml/m2 after D. Comparison of the hemodynamic parameters under ergometric stress before and 20 min after D shows that, on termination of stress, the filling pressure of the left ventricle is reduced. This behavior can largely be attributed to the reduction of the systolic pressure after D (maximal value before D 181, after D 167 mm Hg). Also, the stress-induced increase in the heart rate takes a flatter course after D than before it. The results obtained thus provide evidence that, at a dosage of 0.3 mg/kg, D has no significant negative inotropic effect and probably leads to a decrease of the myocardial oxygen consumption reducing the systolic pressure and, to a lesser degree, heart rate.
8-Chloro-6-[(1-isopropyl-3-imidazolin-2-yl)-methyl]-1,6-benzoperhydrothiazocin-hydrochloride (daz... more 8-Chloro-6-[(1-isopropyl-3-imidazolin-2-yl)-methyl]-1,6-benzoperhydrothiazocin-hydrochloride (dazolicin, ucb B 192) is a new antiarrhythmic drug with direct membrane action which was applied both orally and parenterally. The immediate antiarrhythmic effect of a single i.v. injection of 150 mg of dazolicin on the average was investigated in 28 patients with various types of arrhythmia. After i.v. injection the drug proved to have very strong antiarrhythmic potency and rather a low incidence of side effects. Ectopic beats and paroxysmal tachycardias of both ventricular and supraventricular origin were successfully treated with dazolicin. The antiarrhythmic drug significantly increased the duration of both the QRS- and QT-interval after correction for frequency but it had no detectable effects on the atrioventricular conduction time. After i.v. administration the antiarrhythmic effects of the drug lasted for several hours. The elimination half-life of dazolicin was 7 h. Oral treatment with dazolicin was attempted in 10 patients suffering from stable extrasystolic arrhythmia with daily doses ranging from 3 x 25 mg to 3 x 50 mg. In only 4 patients ectopic beats could sufficiently be eliminated. According to the low dosage the maximum serum concentrations after oral application were significantly lower than after i.v. injection. In two patients serious side effects were observed, such as paroxysmal ventricular fibrillation and an increase in frequency and polymorphism of ventricular ectopic beats. In both instances the patients were suffering from congestive heart failure and they had TU abnormalities in the ECG.
In 11 patients (9 men, 2 women) with angiographically confirmed coronary heart disease, hemodynam... more In 11 patients (9 men, 2 women) with angiographically confirmed coronary heart disease, hemodynamics, myocardial blood flow, oxygen consumption and lactate extraction were measured at rest before and after administration of 0.3 mg diltiazem per kg body weight. There was a prompt and sustained drop in mean systolic arterial pressure from 141 mm Hg to 127 mm Hg along with a reduction in total peripheral resistance. The filling pressure of the left ventricle remained constant following a post-injection rise lasting up to 5 minutes. A marked sustained drop in heart rate from 82/min to 73/min was registered. Concomitantly, stroke volume index rose from 39 to 49 ml/m2. Due to the decrease in load and frequency, contractility parameters dP/dt and dP/dt/P dropped slightly. Myocardial blood flow did not change. On the other hand, a decrease in the difference between arterial and coronary venous oxygen content indicated a coronary dilatory effect. Fifteen minutes after injection, myocardial oxygen consumption had dropped from 11.6 to 10 ml O2/min and 100 g of tissue. There was no substantial change in lactate extraction. Through a drop in peripheral arterial resistance and heart rate, diltiazem leads to a measurable decrease in myocardial oxygen consumption while the patient is still at rest. At the same time, there are indications of a coronary dilatory effect.
A complex binomial bandpass filter is suggested for the analysis of ECG and MCG signals. Theoreti... more A complex binomial bandpass filter is suggested for the analysis of ECG and MCG signals. Theoretical background and details of the appropriate design of these filters are given. Application of these digital filters on ECG/MCG signals provide bandpass signals. Envelope and phase of these signals are used for analysing high frequency components in cardiac signals. Phase variance changes are used to select time intervals dominated by cardiac activity. Mean and variance of the envelope characterize the regularity of the depolarisation process. Two parameters derived from these quantities are used to separate MCGs of patients suffering from ventricular arrhythmia from MCGs of healthy persons
Herzschrittmachertherapie und Elektrophysiologie, 2000
ABSTRACT The spread of electrical endo- and epicardial activation is projected also to body surfa... more ABSTRACT The spread of electrical endo- and epicardial activation is projected also to body surface and can be deducted from various numbers of recording points at the front or the back of the thorax. The resulting data are visualized in a body surface map (BSM). To characterize this activation, the amplitudes are measured and then evaluated according to the origin, the position of the extrema, and the zero line between them. To minimize the BSM data during the activation cycle, the area underneath the QRS complex and/or the ST-T wave may be calculated and plotted as an iso-area BSM. Similarities between the various BMSs are evaluated either by visual comparison or by means of correlation algorithms. The results exceeded the precision of standard ECG recordings in measuring de- and repolarization. Comparison between a succession of paced maps resulted in the precise localization of arrhythmogenic sources. Due to the inhomogeneities of the human thorax direct measurement of the position of an electric source, e.g., the focus of ventricular tachycardia or extrasystole, has not yet been accomplished. Magnetocardiographic mapping, a novel method to record the heart‘s magnetic field, however, allows for direct measurement of the arrhythmic origin since this method is not sensitive to these inhomogeneities. Various examples of the clinical application of BSM have been described in this paper and their results discussed. Die Ausbreitung der elektrischen endo- und epikardialen Aktivierung ist auch auf die Körperoberfläche projiziert und kann dort von einer Vielzahl von dosalen und ventralen Ableitungspunkten als Körperoberflächen-Mapping (BSM) registriert werden. Um diese Aktivierung zu diagnostischen Zwecken zu charakterisieren, werden die früheste Erregung, die Extremata und die dazwischen liegende Nulllinie verwendet. Um den Datenumfang zu minimieren, wird die Fläche unter dem QRS bestimmt und ein Iso-Area-BSM gebildet. Diese Maps werden durch visuellen Vergleich oder durch die Berechnung der Korrelation miteinander verglichen. Abnorme Änderungen der De- und Repolarisation werden damit ebenso ermittelt wie die Lokalisation von Arrythmie-Herden. Letzteres erfolgt im Vergleich zu zuvor durch Stimulation ermittelten Map-Konfigurationen. Aufgrund der Inhomogenität des Thorax ist eine direkte Messung der elektrischen Quelle nicht möglich. Die Magnetokardiographie jedoch, mit der das durch die elektrische Aktivierung des Herzens erzeugte magnetische Feld gemessen wird, erlaubt die Messung des Ursprungsortes, da diese Methode nicht wesentlich von diesen Inhomogenitäten abhängig ist. Verschiedene klinische Anwendungsbeispiele werden in dieser Arbeit referiert und diskutiert.
Bandlimited frequency components are used to estimate the variability of QRS-shape and heart rate... more Bandlimited frequency components are used to estimate the variability of QRS-shape and heart rate. Utilising complex binomial filters, the applied signal processing method allows to analyse envelope and phase (current frequency) of the bandpass signal independently of each other. A beat-to-beat analysis of envelope and current frequency of the entire QRS interval gives an estimate of the QRS variability. A short term heart rate variability is calculated in terms of the heart frequency deviation of the continuously filtered cardiac signal which is determined by the bandwidth of the envelope spectrum in the vicinity of the mean beat frequency. Mean-to-standard deviation ratio of the envelope and current frequency and the heart frequency deviation are combined to a parameter that separate cardiac signals of patients suffering from ventricular arrhythmia from cardiac signals of healthy persons
In 20 infarct patients, whose age varies from 43 to 78 years (m 59.6), continuous hemodynamic mea... more In 20 infarct patients, whose age varies from 43 to 78 years (m 59.6), continuous hemodynamic measurements were made to determine the cardiovascular effects of propranolol without and during a simultaneous infusion treatment with nitroglycerin. In cases of compensated ventricular function and pulmonary wedged pressures of 15 mm Hg or less (N = 10), a mean intravenous propranolol dose of 6.1 +/- 1.3 mg led to a significant reduction of the LVSWI and a simultaneous increase of the PCP by 31% of the control value (P less than or equal to 0.005). A simultaneously performed infusion treatment with nitroglycerin at a mean dose of 3.0 +/- 1.6 mg/h resulted in totally cutting off the propranolol-induced PCP increase, whereas a decrease of the heart rate and the LVSWI due to a beta-receptor-blockade remained completely unchanged. In the case of pre-existing congestion insufficiency of the left ventricle (N = 10) and of a pulmonary wedged pressure of above 15 mm Hg, the administration of a mean dose of propranolol of 5.8 +/- 1.1 mg for protection of the myocardium resulted in a partly disquieting decrease of the volume of cardiac output (P less than or equal to 0.005) which was 28% of the control value for the CI an 12% for the SVI. Correspondingly the left ventricular stroke work decreased to 18%. Nitroglycerin has a reducing influence on these changes, but not down to the initial level. In cases of sufficient ventricular function, propranolol has a favorable influence on the myocardial O2-metabolism via its depressor effect on heart rate and contractility. By means of nitroglycerin, an increase of the pulmonary wedged pressure occurring under this condition can be inhibited. However, in the case of a pre-existing congestion insufficiency, propranolol can lead to a partly disquieting depression of the circulation, which, apart from the hemodynamic risks, makes a rather unfavorable influence on the myocardial O2-metabolism seem likely.
A controlled trial in 149 patients admitted to a district hospital with probable myocardial infar... more A controlled trial in 149 patients admitted to a district hospital with probable myocardial infarction tested the effect of 30 units of anisoylated plasminogen streptokinase activator complex (APSAC) on indices of infarct size. Patients were grouped prospectively according to whether they entered the trial within two and a half hours (early entry) or between two and a half and four hours (late entry) after onset ofthe symptoms. Sixty seven of 73 patients in the control group showed increased plasma activity of myocardial creatine kinase isoenzyme that was diagnostic of infarction compared with only 60 of 76 who received APSAC. The difference was significant overall but occurred predominantly in the early entry group. The patients who received APSAC had more early ventricular arrhythmias, compatible with reperfusion, and showed greater preservation of R waves during admission to hospital. Unwanted effects were generally minor and more common in the actively managed group than the control group (26% v 3%). After nine to 12 months offollow up 12 patients in the control group had died compared with seven in the actively managed group.
ZUSAMMENFASSUNG Hintergrund: Telemonitoring kann die Versorgung, die Lebensqualität und die Progn... more ZUSAMMENFASSUNG Hintergrund: Telemonitoring kann die Versorgung, die Lebensqualität und die Prognose von Patienten mit chronischen Erkrankungen verbessern. Die Übersichtsarbeit fasst den Stand der Versorgungsforschung zum Telemonitoring zusammen und legt einen Schwerpunkt auf Patienten mit chronischer Herzinsuffizienz. Methode: Selektive Literaturrecherche über die Datenbank Medline mit Fokus auf randomisierte kontrollierte Studien (6/2001 bis 5/2008). Ergebnisse: Trotz der insgesamt geringen Datenlage zum Monitoring von Vitalsignalen zeigt sich insgesamt eine Evidenz bezüglich der Verbesserung klinischer Endpunkte, insbesondere der Sterblichkeit. Im Hinblick auf die Verbesserung patientenbezogener Endpunkte, zum Beispiel der Lebensqualität, steht der Nachweis noch aus. Schlussfolgerung: Trotz der Hinweise für die Wirksamkeit von Telemonitoring fehlt es an Evidenz, welches Modell der Versorgung über Telemonitoring, das heißt Vitalparametermonitoring versus strukturiertes Telefonmonitoring, die besten Ergebnisse erzielt. Kritisch ist anzuführen, dass die isolierten Wirkmechanismen des häuslichen Telemonitorings noch nicht vergleichend in ihrer Effektivität geprüft wurden.
Nineteen patients in the acute stage of transmural myocardial infarction were given 20 mg nifedip... more Nineteen patients in the acute stage of transmural myocardial infarction were given 20 mg nifedipine orally under haemodynamic control. Two groups were differentiated according to the original left ventricular filling pressure: group 1 pressure less than or equal to 15 mm Hg (n1 = 8), group 2 pressure > 15 mm Hg (n2 = 11). In both groups a significant drop in peripheral resistance and thus arterial mean pressure was found 1-2 hours after ingestion of nifedipine. in the compensated patients in group 1 it led to lowering of the left ventricular stroke-work index with virtually unchanged heart rate and constant cardiac index. The lower initial values for stroke-work index in the decompensated group 2 were not influenced by nifedipine. In the patients of group 2 a small but yet significant lowering of the left ventricular filling pressure was obtained with original values of 22.6 mm Hg on average. Thus the use of nifedipine in the acute phase of myocardial infarction leads to a more economical cardiac action in compensated patients. In decompensated cases the results do not deteriorate, and the tendency to reduction of left ventricular filling pressure may even result in a recompensation of the left ventricle.
The acute hemodynamic effects of the Ca-antagonist Diltiazem were measured in the course of diagn... more The acute hemodynamic effects of the Ca-antagonist Diltiazem were measured in the course of diagnostic cardiac catheter examinations in 10 patients with coronary heart disease. After initial step-wise ergometric stress, Diltiazem (D) was applied intravenously for 5 min at a dose of 0.3 mg/kg. The effects on right and left ventricular performance as well as on arterial pressure and heart rate were registered 1, 3, 5, 10 and 15 min after termination of the infusion. Then, a second period of ergometric exertion under identical stress conditions was performed. The results under resting conditions show that D effects a significant increase in left ventricular filling pressure (p greater than 0.005), which, however, only lasts a few minutes. After D, the systolic and mean arterial pressure decreases significantly (p greater than 0.001); there is no reflex-induced increase in the heart rate, which on the contrary is significantly lower (p greater than 0.005) 15 min after termination of the infusion than the initial value. The stroke volume index increases from 40 to maximally 48 ml/m2 after D. Comparison of the hemodynamic parameters under ergometric stress before and 20 min after D shows that, on termination of stress, the filling pressure of the left ventricle is reduced. This behavior can largely be attributed to the reduction of the systolic pressure after D (maximal value before D 181, after D 167 mm Hg). Also, the stress-induced increase in the heart rate takes a flatter course after D than before it. The results obtained thus provide evidence that, at a dosage of 0.3 mg/kg, D has no significant negative inotropic effect and probably leads to a decrease of the myocardial oxygen consumption reducing the systolic pressure and, to a lesser degree, heart rate.
8-Chloro-6-[(1-isopropyl-3-imidazolin-2-yl)-methyl]-1,6-benzoperhydrothiazocin-hydrochloride (daz... more 8-Chloro-6-[(1-isopropyl-3-imidazolin-2-yl)-methyl]-1,6-benzoperhydrothiazocin-hydrochloride (dazolicin, ucb B 192) is a new antiarrhythmic drug with direct membrane action which was applied both orally and parenterally. The immediate antiarrhythmic effect of a single i.v. injection of 150 mg of dazolicin on the average was investigated in 28 patients with various types of arrhythmia. After i.v. injection the drug proved to have very strong antiarrhythmic potency and rather a low incidence of side effects. Ectopic beats and paroxysmal tachycardias of both ventricular and supraventricular origin were successfully treated with dazolicin. The antiarrhythmic drug significantly increased the duration of both the QRS- and QT-interval after correction for frequency but it had no detectable effects on the atrioventricular conduction time. After i.v. administration the antiarrhythmic effects of the drug lasted for several hours. The elimination half-life of dazolicin was 7 h. Oral treatment with dazolicin was attempted in 10 patients suffering from stable extrasystolic arrhythmia with daily doses ranging from 3 x 25 mg to 3 x 50 mg. In only 4 patients ectopic beats could sufficiently be eliminated. According to the low dosage the maximum serum concentrations after oral application were significantly lower than after i.v. injection. In two patients serious side effects were observed, such as paroxysmal ventricular fibrillation and an increase in frequency and polymorphism of ventricular ectopic beats. In both instances the patients were suffering from congestive heart failure and they had TU abnormalities in the ECG.
In 11 patients (9 men, 2 women) with angiographically confirmed coronary heart disease, hemodynam... more In 11 patients (9 men, 2 women) with angiographically confirmed coronary heart disease, hemodynamics, myocardial blood flow, oxygen consumption and lactate extraction were measured at rest before and after administration of 0.3 mg diltiazem per kg body weight. There was a prompt and sustained drop in mean systolic arterial pressure from 141 mm Hg to 127 mm Hg along with a reduction in total peripheral resistance. The filling pressure of the left ventricle remained constant following a post-injection rise lasting up to 5 minutes. A marked sustained drop in heart rate from 82/min to 73/min was registered. Concomitantly, stroke volume index rose from 39 to 49 ml/m2. Due to the decrease in load and frequency, contractility parameters dP/dt and dP/dt/P dropped slightly. Myocardial blood flow did not change. On the other hand, a decrease in the difference between arterial and coronary venous oxygen content indicated a coronary dilatory effect. Fifteen minutes after injection, myocardial oxygen consumption had dropped from 11.6 to 10 ml O2/min and 100 g of tissue. There was no substantial change in lactate extraction. Through a drop in peripheral arterial resistance and heart rate, diltiazem leads to a measurable decrease in myocardial oxygen consumption while the patient is still at rest. At the same time, there are indications of a coronary dilatory effect.
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