A technique for the routine recording of His bundle (H) activity in man using a bipolar or multipolar catheter is described. The recording catheter is inserted percutaneously, via the Seldinger method, into the right femoral vein and advanced fluoroscopically into the right atrium. Placement of the pre-formed curve at the catheter tip across the tricuspid valve in nine patients resulted in stable recordings of His bundle activity in successive cardiac cycles. Right atrial pacing resulted in progressive lengthening of the P-H interval with increasing frequency but the H to S-wave interval remained constant at all rates. Similar lengthening of the P-H interval was produced during atrial pacing when pressure was applied to the carotid sinus. The use of this recording technique in man will facilitate diagnostic interpretation of the electrocardiogram and can be used in various investigations of atrioventricular and intraventricular conduction in man.

To evaluate the effect of different levels of arterial oxygen content on hemodynamic parameters during exercise nine subjects performed submaximal bicycle or treadmill exercise and maximal treadmill exercise under three different experimental conditions: 1) breathing room air (control); 2) breathing 50% oxygen (hyperoxia); 3) after rebreathing a carbon monoxide gas mixture (hypoxia). Maximal oxygen consumption (Vo2 max) was significantly higher in hyperoxia (4.99 1/min) and significantly lower in hypoxia (3.80 1/min) than in the control experiment (4.43 1/min). Physical performance changes in parallel with Vo2 max. Maximal cardiac output (Qmax) was similar in hyperoxia as in control but was significantly lower in hypoxia mainly due to a decreased stroke volume. A correlation was found between Vo2 max and transported oxygen, i.e., Cao2 times Amax, thus suggesting that central circulation is an important limiting factor for human maximal aerobic power. During submaximal work HR was decreased in hyperoxia and increased in hypoxia. Corresponding Q values were unchanged except for a reduction during high submaximal exercise in hyperoxia.

THE EFFECTS of heart rate on cardiovascular dynamics have been investigated in both human and animal studies.1-8 When the heart rate is altered by a change in state such as exercise, during ventricular pacing, or with the use of pharmacological agents, there are marked changes in cardiac output and other hemodynamic parameters.The purpose of this study was to investigate the effect of controlled heart rates on the hemodynamics in man at rest and during exercise. The neurohumoral stimuli to the heart remained constant in each of the states tested, rest and exercise,9 and ventricular activation was unaltered by controlling the heart rate with atrial pacing. MethodsTen normal male volunteers ranging from 25 to 45 years of age were studied at cardiac catheterization at rest and during exercise. Right heart catheterization was performed in the postabsorptive, nonsedated state. A bipolar pacemaker catheter was positioned in the right atrium and a Cournand lumen catheter was positioned in the pulmonary artery. The brachial artery was cannulated with an arterial needle.The right atrial electrode catheter was connected to a cardiac pacemaker* and the heart rate was controlled by atrial pacing. Cardiac outputs were determined by the indicator-dilution technique,10 using indocyanine green and a Gilford densitometer. The dye was injected into the pulmonary artery and the blood was sampled

The technique of recording His bundle electrograms in man by a tripolar electrode catheter was applied in a study of patients with first, second, and third-degree heart block. In all patients with first-degree heart block (congenital, acquired, or induced by atrial pacing), the delay in A-V conduction occurred proximal to the His bundle as evidenced by a prolonged P-H interval. The enhancement of A-V conduction (shortening the P-H interval) due to isoproterenol was qualitatively similar in the three forms of first-degree block. In cases of Wenckebach phenomenon the P-H interval progressively increased until a dropped beat occurred. The nonconducted P wave was not followed by a His deflection, indicating block proximal to the His bundle. Cases of 2:1 and 3:1 block occurring proximal to the His bundle were also studied. The usefulness of His-bundle recordings in the diagnosis of cases of complete and incomplete bilateral bundle-branch block is also demonstrated.

The technique of recording electrograms of the His bundle, using a tripolar electrode catheter positioned across the tricuspid valve, was applied in a physiological study of atrioventricular conduction in man. Increasing the heart rate to 160 beats/min by right atrial pacing produced progressive prolongation of the P-H interval while the H-Q interval remained constant. At any given paced heart rate, digitalis caused a prolongation of the P-H interval. Isoproterenol and atropine markedly shortened the P-H interval at any given heart rate. Neither drug had any significant effect on the H-Q interval.

The effects of electrical stimulation of the carotid sinus on sinus rate and atrioventricular (A-V) conduction were studied before and after alternate interruption of the vagi and sympathetic nerves to the heart in dogs. In group I, carotid sinus stimulation caused a similar absolute decrease in sinus rate before and after vagotomy, although after vagotomy the response was more latent. Subsequent administration of propranolol blocked the effects of carotid sinus stimulation on sinus rate. In group II (dogs with intact vagi), the effects of carotid sinus stimulation and bilateral occlusion of the common carotid artery on sinus rate were abolished by bilateral stellatectomy and upper thoracic ganglionectomy. In group III, the effects of carotid sinus stimulation on A-V conduction during atrial pacing at a fixed rate were not significantly altered by vagotomy and were blocked by subsequent administration of propranolol. In group IV, carotid sinus stimulation had no effect on A-V conduction after sympathetic denervation. It is concluded that the effects of the carotid sinus reflex on the heart are mediated primarily by the sympathetic nervous system efferents. In addition, evidence suggesting that sympathetic tone is a major determinant of vagal tone has been presented.

No abstract

No abstract