Table Of ContentWHA T'S NEW IN ELECTROCARDIOGRAPHY
WHAT'S NEW IN
ELECTROCARDIOGRAPHY
edited by
H.J.J. WELLENS and H.E. KULBERTUS
University of Limburg University of Liege
Department of Cardiology School of Medicine
Annadal Hospital Division of Cardiology
Maastricht Liege
•
1981
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Library of Congress Cataloging in Publication Data
Main entry under title:
What's new in electrocardiography.
Includes Index.
I. Electrocardiography. I. Wellens, H.J.J. II. Kulbertus, Henri.
RC683.5.E5W44 616.10207543 81-4032 AACR2
ISBN -13:978-90-247 -2452-9 e-ISBN -13:978-94-009-8239-0
001: 10.1007/978-94-009-8239-0
Copyright © 1981 by Martil1lls NijhoJl Publishers, The Hague.
Sqttcover reprint l!f the hardClil'er 1st edition 1981
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in
any .form or by any means, mechanical, photocopying, recording, or otherwise, witholll the prior written
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Matinus NijhofJ Publishers, P.O. Box 566, 2501 eN The Hague, The Netherlands.
FOREWORD
The saying, "What one does not know, one does not recognize", applies to the
interpretation of the electrocardiogram.
Recently a wealth of new information on the electrocardiogram has become avail
able by correlating electrocardiographic findings with information from new techniques
such as His bundle recordings, programmed stimulation of the heart, 24-hour record
ing~, and cardiac scintigraphy. Also, our knowledge about the electrocardiogram has
been extended by acquiring new epidemiologic data and by follow-up studies on
patients with myocardial infarction and bundle branch block.
Unfortunately, this new information has to be dug out of several different journals
and books. This book brings together this information and ,helps the practicing physi
cian in updating his or her knowledge about the 12-lead electrocardiogram as a
diagnostic, therapeutic, and prognostic tool.
Hein J.1. WELLENS Henri E. KULBERTUS
ACKNOWLEDGMENTS
Originally, the contents of this book were presented in a workshop on "What is new
in electrocardiography?" This workshop was made possible by the generous financial
support and assistance of Roussel Nederland. Each of the speakers at the workshop
kindly consented to produce a manuscript. We want to express our gratitude to
them.
The preparation of the workshop, and this book, required a great amount of
secretarial assistance: Mrs. Bea Leliveld, Miss Anja Smeets, and Mrs. Thea Niemeyer
did this with dedication and efficiency. They surely deserve our thanks.
Mr. B.F. Commandeur and Martinus Nijhoff Publishers were responsible for the
rapid and expert production of this book.
Hein J.J. WELLENS Henri E. KULBERTUS
CONTENTS
1. Prognostic significance of the electrocardiogram in patients with coronary
heart disease
Z. JUMA, A. CASTELLANOS, and RJ. MYERBURG
2. Correlation between electrocardiographic and scintigraphic findings in myo
cardial infarction
P. RIGO, J.-P. SMEETS, V. LEGRAND, C. RIGO-BETZ, and H.E. KULBERTUS 23
3. Assessment of the value of electrocardiographic signs for myocardial infarc
tion in left bundle branch block
FJ.Th. WACKERS, K.I. LIE, G. DAVID, R.M. KOSTER, and HJJ. WELLENS 37
4. Electrocardiographic diagnostic dilemmas in myocardial ischemia and infarc
tion
W.J. MANDEL, C.T. PETER, and I. HOFFMAN 58
5. Electrocardiographic diagnosis of myocardial infarction in pacemaker pa
tients
B. DODINOT, L. KUBLER, and J.P. GODENIR 79
6. Relation between exercise electrocardiogram and extent of coronary artery
disease
J.-M.R. DETRY and J.A. MELIN 91
7. Prognostic value of limited exercise testing before hospital discharge follow
ing myocardial infarction
D.D. WATERS. and P. THEROUX 102
8. Approach to the patient with bundle branch block
D.L. Ross 111
9. The value of the electrocardiogram in diagnosing site of origin and mecha
nism of supraventricular tachycardia
J. FARRE and HJJ. WELLENS 131
10. The short PR internal
B.M. KENNELLY 172
11. The differentiation between ventricular tachycardia and supraventricular
tachycardia with aberrant conduction: the value of the 12-lead electrocardio
gram
HJJ. WELLENS, F.W. BAR, EJ. VANAGT, P. BRUGADA, and 1. FARRE 184
viii
12. Relation between site of origin and QRS configuration in ventricular
rhythms
M.E. JOSEPHSON, H.L. WAXMAN, F.E. MARCHLINSKI, L.N. HOROWITZ, and S.R.
SPIELMAN 200
13. Torsade de Pointes
P. TOUBOUL 229
14. Electrocardiographic diagnosis of pacemaker malfunction
S.S. BAROLD, M.D. FALKOFF, L.S. ONG, and R.A. HEINLE 236
15. Electrocardiographic changes occurring with advancing age
H.E. KULBERTUS, F. DE LEVAL-RUTTEN, A. ALBERT, M. DUBOIS, and J.-M.
PETIT 300
16. The electrocardiogram in digitalis intoxication
E.J. VANAGT and H.J.J. WELLENS 315
17. Holter monitoring and cardiac rhythm
M.D. ROSENGARTEN, J.F. LECLERCQ, P. ATTUEL, and Ph. COUMEL 344
. 18. The electrocardiogram in pulmonary embolism
P. BRUGADA, A.P. GORGELS, and H.J.J. WELLENS 366
Index 381
CONTRIBUTORS
Albert, Adelin. Department of Clinical Chemistry, University Hospital, Liege, Bel
gium.
Attuel, Patrick. H6pital Lariboisiere, F-75475 Paris-Cedex 10, France.
Bar, Frits W. Department of Cardiology, University of Limburg, Annadal Hospital,
6200 MD Maastricht, The Netherlands.
Ba~old, S. Serge. Cardiology Division, Genesee Hospital, Rochester, New York 14607,
USA.
Brugada, Pedro. Department of Cardiology, University of Limburg, Annadal Hospital,
6200 MD Maastricht, The Netherlands.
Castellanos, Agustin. Division of Cardiology, Department of Medicine, University of
Miami School of Medicine, P.O. Box 016960, Miami, Florida 33101, USA.
Coumel, Philippe. H6pital Lariboisiere, F-75475 Paris-Cedex 10, France.
David, George K. Department of Cardiology, Wilhelmina Gasthuis, University of
Amsterdam, Amsterdam, The Netherlands.
De Leval-Rutten, Fran'Yoise. Department of Clinical Chemistry, University Hospital,
Liege, Belgium.
Detry, Jean-Marie. Division of Cardiology, University of Louvain, Clinique Saint Luc,
Avenue Hippocrate 10, B-1200 Bruxelles, Belgium.
Dodinot, Bernard. Clinique Cardiologique, Centre Hospitalier Universitaire Nancy,
F-54500 Vandoeuvre, France.
Dubois, Marie. SPJMP Province de Liege, Liege, Belgium.
Falkoff, Michael D. Cardiology Division, Genesee Hospital, Rochester, New York
14607, USA.
Farn~, Jeronimo. Servicio de Cardiologia, Fundacion Jimenez Diaz, Clinica Nasa de la
Concepcion, Universidad Autonoma, Madrid, Spain.
Godenir, Jean Pierre. Clinique Cardiologique, Centre Hospitalier Universitaire Nancy,
F-54500 Vandoeuvre, France.
Gorgels, Anton M. Department of Cardiology, University of Limburg, Annadal Hos
pital, 6200 MD Maastricht, The Netherlands.
Heinle, Robert A. Cardiology Division, Genesee Hospital, Rochester, New York
14607, USA.
Hoffman, Irwin. Department of Electrocardiography, Cedars-Sinai Medical Center, Los
Angeles, California 90048, USA.
Horowitz, Leonard N. Electrophysiology Laboratory, Cardiovascular Section, Depart-
x
ment of Medicine, 666 White Building, Hospital of the University of Pennsylvania,
3400 Spruce Street, Philadelphia, Pennsylvania 19104, USA.
Josephson, Mark E. Electrophysiology Laboratory, Cardiovascular Section, D~partment
of Medicine, 666 White Building, Hospital of the University of Pennsylvania, 3400
Spruce Street, Philadelphia 19104, USA.
Juma, Zulfikar. Division of Cardiology, Department of Medicine, University of Miami
School of Medicine, P.O. Box 016960, Miami, Florida 33101, USA.
Kennelly, Brian M. Department of Cardiology, University of Louisville School of
Medicine, 323 East Chestnut Street, Louisville, Kentucky 40202, USA.
Koster, Rudolph M. Department of Cardiology, Binnen Gasthuis, University of
Amsterdam, Amsterdam, The Netherlands.
Kulbertus, Henri E. Cardiology Section, Institute of Medicine, University of Liege,
Hopital de Baviere, Blvd. de la Constitution 66, B-4020 Liege, Belgium.
Kubler, Louis. Clinique Cardiologique, Centre Hospitalier Universitaire Nancy,
F-54500 Vandoeuvre, France .
. Leclercq, Jean F. Hopital Lariboisiere, F-75475 Paris-Cedex 10, France.
Legrand, Victor. Cardiology Section, Institute of Medicine, University of Liege, Hopi
tal de Baviere, Blvd. de la Constitution 66, B-4020 Liege, Belgium.
Lie, K.I. Department of Cardiology, Wilhelmina Gasthuis, University of Amsterdam,
Amsterdam, The Netherlands.
Mandel, William J. Department of Electrocardiography, Cedars-Sinai Medical Center,
Los Angeles, California 90048, USA.
Marchlinski, Francis E. Electrophysiology Laboratory, Cardiovascular Section, Depart
ment of Medicine, 666 White Building, Hospital of the University of Pennsylvania,
3400 Spruce Street, Philadelphia, Pennsylvania 19104, USA.
Melin, Jacques A. Division of Cardiology, University of Louvain, Clinique Saint Luc,
Avenue Hippocrate 10, B-1200 Bruxelles, Belgium.
Myerburg, Robert J. Division of Cardiology, Department of Medicine, University of
Miami School of Medicine, P.O. Box 016960, Miami, Florida 33101, USA.
Ong, Ling S. Cardiology Division, Genesee Hospital, Rochester, New York 14607,
USA.
Peter, C. Thomas. Department of Electrocardiography, Cedars-Sinai Medical Center,
Los Angeles, California 90048, USA.
Petit, Jean-Marie. Institut E. Malvoz, Quai du Barbon, Liege, Belgium.
Rigo, Pierre. Cardiology Section, Institute of Medicine, University of Liege, Hopital de
Baviere, Blvd. de la Constitution 66, B-4020 Liege, Belgium.
Rigo-Betz, Christine. Cardiology Section, Institute of Medicine, University of Liege,
Hopital de Baviere, Blvd. de la Constitution 66, B-4020 Liege, Belgium.
Rosengarten, Michael D. McGill University, Montreal General Hospital, Montreal,
Canada.
Ross, David L. Division of Cardiology, Stanford University Medical Center, Stanford,
California 94305, USA.
Smeets, Jean-Pierre. Cardiology Section, Institute of Medicine, University of Liege,
Xl
Hopital de Baviere, Blvd. de la Constitution 66, B-4020 Liege, Belgium.
Spielman, Scott R. Electrophysiology Laboratory, Cardiovascular Section, Department
of Medicine, 666 White Building, Hospital of the University Pennsylvania, 3400
Spruce Street, Philadelphia, Pennsylvania 19104, USA.
Theroux, Pierre. Department of Medicine, Montreal Heart Institute, and University of
Montreal Medical School, 500 East Belanger Street, Montreal, HIT 1C 8 Quebec,
Canada.
Touboul, Paul. Hopital Cardio-Vasculaire et Pneumologique, F-69894 Lyon-Cedex 3,
France.
Vanagt, Edgar J. Department of Cardiology, University of Limburg, Annadal Hospital,
6200 MD Maastricht, The Netherlands.
Wackers, Frans J.Th. Cardiology Section, Department of Internal Medicine, Yale
University School of Medicine, New Haven, Connecticut 06510, USA.
Waters, David D. Department of Medicine, Montreal Heart Institute, and University
o( Montreal Medical School, 5000 East Belanger Street, Montreal, HIT lC8 Quebec,
Canada.
Waxman, Harvey L Electrophysiology Laboratory, Cardiovascular Section, Depart
ment of Medicine, 666 White Building, Hospital of the University of Pennsylvania,
3400 Spruce Street, Philadelphia, Pennsylvania 19104, USA.
Wellens, Hein U. Department of Cardiology, University of Limburg, Annadal Hospi
tal, 6200 MD Maastricht, The Netherlands.
