INTRACARDIAC ELECTROGRAPHY IN THE INVESTIGATION OF CONGENITAL HEART DISEASE IN INFANCY AND THE NEONATAL PERIOD

Abstract

Though cardiac surgery has advanced rapidly and provided a constant stimulus to the development of precise diagnostic methods, the highest mortality from congenital heart disease is still in the first year of life and there is, as yet, no suitably sized pump oxygenator available for very small children. There seems little doubt, however, that before long a satisfactory machine will be developed and we should, therefore, in anticipation, be modifying and adapting our diagnostic methods to suit infants and very young children who present special problems to the cardiologist. Many of them are ill or in heart failure and intracardiac manipulations have to be very gentle in such cases- the heart being only about the size of a walnut and often very irritable. Cardiac catheterization may have to be abandoned at any stage, so speed is essential and any method of reducing the length of the investigation is of value. This paper illustrates a few of the ways in which the routine use of intracardiac electrography can make cardiac catheterization in infants and the newborn quicker, safer and more informative. METHOD Intracardiac electrograms are easily obtained using standard production United States Catheter and Instrument Corporation catheters. Similar to Cournand single lumen catheters with the addition of an electrode ring flush with the surface one or two millimetres from the distal tip, they are obtainable in all sizes from 5F to 14F and 50, 100 or 125 cm. long. A wire conductor runs down spirally in the wall from the electrode to a terminal contact at the proximal end of the catheter, and some simple device is required to connect this to suitable recording apparatus. Many small technical difficulties may be encountered before good reproducible records are obtained, but most of them are easily overcome-careful suppression of A.C. interference and the maintenance of a completely dry field are probably the most important.