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The study includes 702 patients (with left ventricular load, myocardial infarction and bundle branch block) and 130 healthy persons. To all these a spatial velocity EKG was made (SVEKG) as well as corrected orthogonal electro- and vectorcardiogram according to Frank, spatial ECG and standard EKG in 12 leads. The indices of the spatial velocity ECG were compared with those of the other methods on the basis of the criteria sensitivity and specificity. In the patients with right ventricular load the indices of the spatial electrocardiography showed the highest sensitivity; in the patients with left ventricular load and bundle branch block the indices of the corrected orthogonal electrocardiography showed the highest sensitivity. In the patients with myocardial infarction the potentials of several methods were equal. The insufficient number of investigations concerning the spatial velocity ECG cannot give a clear view of its potentials and its place in the clinical practice but some of its advantages make it very convenient for preparing a system of automatic analysis of the heart electrophysiological signal.

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130 healthy persons and 146 cardiac patients with left ventricular cardiac overload were examined by 4 electrophysiologic methods: corrected orthogonal electrocardiogram according to Frank, corrected orthogonal vectorcardiogram, space electrocardiogram, high-speed space electrocardiogram. 76 indices were examined. The cardiac patients were classified into two basic groups: patients with systolic overload and patients with diastolic overload. By variational analysis, performed in all patients, statistically significant differences were found between the cardiac patients and the healthy persons. On the basis of the criteria sensitivity, specificity and assessment of realization the best indices for every method were determined. In order to improve the sensitivity "sets" with sensitivity of 91-96% are established by mathematical calculations. The "sets" are made up of 4 indices from different methods and are suitable for inclusion in computer programs.

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In 216 patients with right ventricular cardiac overload the changes of 76 electrophysiological indices were studied--indices of the corrected orthogonal electrocardiogram after Frank, corrected orthogonal vectorcardiogram, spatial electrocardiogram and high-speed spatial electrocardiogram. The patients with right ventricular cardiac overload are divided into two basic groups--patients with systolic and patients with diastolic overload. The indices are assessed on the basic criteria of sensitivity, specificity and realization. Variation analysis as well as statistical comparison with 119 healthy persons are performed. On the basis of the results of the study "sets" of 4 indices each with 97-98% sensitivity are determined, indices from all methods used are included in the "sets". The conclusion is reached of the good possibilities of the electrophysiological methods when a combination of indices with the help of a computer is made.

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200 patients (181 men and 19 women) with stable stenocardia were examined by the exercise tolerance test. The patients were loaded by the step by step method on veloergometer or threadmill up to 80% of the maximal pulse rate. 126 of the tests were evaluated as positive. False positive were 10 tests and 19 tests were false negative. The coefficient of sensitivity (independently of the limiting factor) was 82.2%, the specificity was 80%, the prognostic value of the positive test was 91.6%, of the negative test--68.3%. The sensitivity coefficient was: in the patients with one affected arterial branch--81.3%; in the patients with two affected arterial branches--80.4%, in the patients with three affected arterial branches--92.5% and in the patients with affection of the main arterial stem--87.5%. The patients were classified into three groups according to the expression of the limiting factors: I group with limiting factor pain (98 patients) with sensitivity coefficient 74.3%, specificity--77.8%, prognostic value of the positive test--89.1% and of the negative test--55.5%. II group with limiting factor ST-depression (83 patients) with sensitivity coefficient 71.3%, specificity--91.7%, prognostic value of the positive test--95% and of the negative test--61.1%. III group with limiting factors both pain and ST-depression with sensitivity coefficient 45.4%, specificity--91.7%, prognostic value of the positive test--95% and of the negative test--61.1%. The main conclusion from the study is that the limiting factor ST-depression as a basic objective sign of myocardial ischemia has high enough specificity and prognostic value and should be considered as a limiting factor with greatest informatory value.

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In 57 patients with recurrent tachycardiac attacks in whom the empiric medical drug treatment failed to prevent the attacks electrophysiological examination was carried out in order to specify the type of the tachycardia. This was followed up by a serial testing of drugs. In 41 patients an antiarrhythmic drug (or a combination of drugs) was found which could prevent the attacks. The prospective follow up of these patients from 3 months up to 4 years revealed that in 36 of them there were no more tachycardiac attacks (90% efficacy). In 11 patients antitachycardia pacemakers were implanted with great efficiency. 9 of the patients had pacemaker type extinguishing and the other two patients had atrio-ventricular pacemaker by a double path in the AV-node. The selection of and antiarrhythmic drug by means of electrophysiological testing and the antitachycardia pacemakers are efficient means against recurrent tachycardias.

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Intracavitary electrophysiological study of the heart (IES) was carried out in 27 patients with WPW syndrome. In 17/27, permanent tachycardia, reentry type was reproduced, in 1/27--unstable and in 2/27--echo phenomenon, in 1/27--atrial fibrillation. In 6/27 no tachycardia was reproduced. In I patient the tachycardia, type reentry "detained" in atrial flutter, and in 2--in ventricular tachycardia (unstable). In all patients IES established the presence of additional connections between auricles and ventricles: to left auricle--9 patients (5 obscure connections out of them), to right auricle--6 patients, to septum--10 patients, James connection--1 and connection of Mahaim--1 patient. IES is a valuable method for reproduction of tachycardia in the existence of anatomic base (additional connection) and proper electrophysiological characteristics (short refractory phases). In parallel with tachycardia, reentry type, atrial and ventricular tachycardia could develop in the patients with WPW, making use of the additional connection. IES contributes to the elucidation of numerous diagnostic and therapeutic problems in the patients with WPW.

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In nine patients with syndrome of ventricular over-excitation of intracavitary electrocardiographic investigation was carried out, including recording of Hiss bundle potentials, right and left auricle, programmed, increment and high frequent stimulations. The anatomic characteristic of the additional connection, on the base of the deformation of QRS-complex and the type of the retrograde conduction in case of ventricular stimulation showed that the connection started from the right auricle. In five--it terminates in the left ventricle, and in four--in the right. In the majority of the patients it is with an effective refractory phase under 300 msec., corresponding to the electrophysiological characteristic of a direct connection between auricles and ventricles. The problem of the origination of the phenomenon of circling excitation in the patients with the syndrome of ventricular overexcitation is discussed.

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The results from the step-wise loading test to 75 per cent of the age maximum pulse rate, performed by veloergemeter or thread-mill in 52 patients (9 females and 43 males, II of them with atypical chest pain and II with stenocardia) were juxtaposed to the data from the selective coronarography. It was established that the a reduction of ST segment greater than I mm and the appearance of precordial pain, degree III by the five-grade scale, have almost identical specificity (70% and 64% resp) and a predicting value of the positive result (68% and 70% resp) and a slightly higher sensitivity to pain (68% and 84% resp) in the detection of coronary stenosis greater than 50 per cent of the diameter of a main coronary vessel. The combination of the signs precordial pain degree III and/or ST reduction greater than I mm and/or elevation of ST greater than 2 mm, with same predicting value (67%) maintained, but with a considerably enhanced sensitivity (96%) proved to be most adequate as a criterion of the positive test. A reduction of ST segment greater than 22 mm is characterized by decrease of sensitivity (40%) but with a considerable increase of specificity (96%). The positivation of that sign suggests the presence mainly of a multibranch disease. The patients with coronary stenosis greater than 50%, rarely reach a physical capacity over 100 wt (7 x oxygen consumption) and a product of the maximum reached pulse rate and systolic blood pressure over 20 000 as compared with those without stenosis, but no difference among the patients with one-branch and multi-branch disease was established. The electrocardiographic changes in the patients with a true positive test with loading is more often retained after 4th minute of the rehabilitation phase as compared with those of the patients with false-positive test. Evidence exists to admit that the predicting value of the positive test is poorer in the patients with atypical pains and females.

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The ECG Mapping from 30 precordial points in 56 patients with recent anterior transmural infarctions was followed up as well as the level of the enzymes, acid phosphokinase, SGOT and LDH-iso during the first 6 days after the origination of the cardiac infarction. Thirty six patients were treated according to the generally adopted treatment schedule of cardiac infarction (group without furanthril) and 20 patients were administered, in addition to the generally adopted schedule, one tablet furanthril daily during the first six days (group with furanthril. Though no manifested discrepancies were observed in the indices studied in both groups (without and with furanthril)--in patients administered furanthril systematically--a better manifested drop was found in ECG Mapping indices and the enzyme activity in the course of the cardiac infarction, as compared with the group without furanthril. In some of the cases that tendency was with a statistical significance. According to clinical data, extensive lesion of myocardium and cardiac rupture were more frequently found in the group without furanthril whereas grave rhythm disorders were more frequent in the group with furanthril. The systematic administration of furanthril, in the first several days after the origination of the cardiac infarction, revealed some favorable tendencies in its course (possible restriction of lesion zone according to ECG Mapping data, restriction of necrosis according to enzyme activity data), but, at the same time, the unfavourable arrhythmia became more frequent, necessitating the control of rhythm and electrolytes as well as timely antirhythm treatment.

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The electrocardiograms of 110 patients with recent myocardial infarction treated and died at CCVD--RI of CVD, MA, were studied. The electrocardiographic image was juxtaposed to the pathological finding. The analysis revealed that 86.3 per cent of the infarctions were diagnosed and localized properly via the 12 routine leads. In the group of undistinguished transmural infarctions (11 patients) the patients with posterior myocardial infarction predominated (8 patients), patients with bundle branch block (1 patient with left bundle branch block, 2 patients with right bundle branch block and 1 patient with left anterior fascicular block) and an opposite healed myocardial infarction was present in six of the patients deceased. Among the deceased with the non-diagnosed non-transmural infarctions (4 patients), three were with a posterior localization, one with left bundle branch block and in all of them--healed myocardial infarctions were found. No complete coincidence between the ECG and pathologoanatomical idea was established as regards non-transmural and transmural myocardial infarction, because in half of the patients with non-transmural infarction, confirmed at necropsy, a pathological O deflection was found. The clinical value of the electrocardiographic classification of myocardial infarctions as transmural and non-transmural is discussed.

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Intracardial electrophysiological examination was conducted in 50 patients with suspicious or confirmed data about disturbed function of sinus node--namely: short-term auricular stimulation for determination of sinoatrial time (SAT) and long-term auricular stimulation with increasing frequency with analysis of the phenomena in the post-stimulation period--time of sinus node recovery (TSNR), corrected recovery time of sinus node (CRTSN=TSNR minus the basal cycle of auricle before stimulation), emerging of ectopic rhythm leaders and secondary pauses. The following data were obtained in the two groups of patients formed: Group I--26 patients with ECG data about disturbed function of sinus node (periods of sinus bradycardia under 40 beats (minute and/or sinus pauses over 1800 msec): SAT identical to 375 +/- 168; TSNR = 2714 +/- 562; CRTSN = 1684 +/- 347; SAT over 400 msec was found in 8 out of 22 patients; TSNR over 1400 msec in 20 out of 26 patients, CRTSN over 550 msec in 20 out of 26 patients. Ectopic rhythm leader occurred in the poststimulation interval in 5 out of 26 patients and in 4 patients--secondary pauses over 1800 msec were observed; Group II--24 patients, with no data about disturbed function of sinus node (according to the upper criteria): SAT = 254 +/- 91; TSNR +/- 1082 +/- 168; CRTSN = 326 +/- 108; SAT over 400 msec was observed in none of the patients from that group. TSNR over 1400 msec (but under 1700 msec) was found in one patient, CRTSN in the same patient and in the rest of that group was under 550 msec. No ectopic rhythm leaders and secondary pauses over 1200 msec were found in that group of patients during the poststimulation interval. SAT, TSNR and CRTSN were shortened with a statistical significance in both the patient groups after the administration of atropine--I mg intravenously and the reexamination but in 5 patients from group I TSNR, CRTSN were paradoxically lengthened and became pathological. The electrophysiological methods for the studies on sinus node and the electrophysiological parameters, obtained via them, could contribute to the characterization and assessment of the functional potentialities of sinus node as well as to a better understanding of the mechanism of its injury.

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The object of the study were 220 patients with a myocardial infarction, confirmed clinically, enzymatically and electrocardiographically. Seventeen indices were studied, processed via variation analysis with 8 sites of the infarction alterations. The results were compared with those in subjects with intact hearts, examined and described by the authors in another study with the aid of the same devices. The size of the maximum space velocity is most significantly decreased in all myocardial sites. The results, summed up for anterior and posterior-inferior sites are also presented. The sensitivity of some of the indices was determined as well as the correlation dependence with the level of serum creatine-phosphokinase. Highest proved to be the sensitivity of the maximum space velocity (100%), an index correlating with the level of serum creatine-phosphokinase between --0.60 and --0.64. Conclusions were drawn referring to some potentialities for a further application of the method.

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The potentials of His bundle were recorded in 25, out of 105 patients with intracardial electrophysiological examination, carried out. The standard electrocardiographic devices were used, being reconstructed for the purpose. The patients with AV block, stage I and partial AV block, Wenckebach type manifested blocking (slow down) above His bundle. The patients with AV block, Möbitz type II and the patients with chronic AV block manifested blocking both above and beneath His bundle. With auricle stimulation with alternative frequency, latent pathological disorders of auricle-ventricular conduction could be manifested. The method allows the localization of the level of the block, aiding the solution of prognosis problems, further behaviour and eventually the setting of artificial guide of cardiac activity.

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The electrocardiographic criteria for left-ventricular loading were studied in patients with non-complicated arterial hypertension and were juxtaposed to the basic hemodynamic indices, determined via radio-isotope method--quantitative radiocardiography. Regular changes in the hemodynamics and electrocardiographic criteria were found, in the initial phases within the limits of the norm, and in the later ones--exceeding it. The method of correlation analysis was applied between the separate hemodynamic indisec and electrocardiographic criteria for left ventricular loading both in the separate subgroups and for the whole group. Correlation dependence with various values and sign were found. Finally, it was concluded that the classic electrocardiographic criteria for left ventricular loading in case of arterial hypertension obtained a new meaning and should be assessed with consideration given to the subjects' age and in a comparison with hemodynamic characteristic.

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A complex spatial analysis of the electromotive cardiac force was performed to 150 subjects with intact hearts, aged from 20 to 55. The extend, direction and rate of the change in the direction and extend of 10, 20, 30, 40, 50, -30, -20, -10 and maximum spatial vectors were analysed. The results were processed according to the method of variation analysis, presented in diagrams and tables. The results obtained, which do not contradict those found in literature, show that the methods applied (graphic and automatic) could successfully be applied in practice and the data obtained--serve as standards for the work with the same apparatuses (Hellige EG-22 with an appliance, constructed and produced in Bulgaria.

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