Progress in exercise electrocardiography.

situation resembling most electrophysiological studies. One other factor in favour of subpectoral automatic cardioverter/defibrillator implantation under local anaesthesia is the reduced complexity of the implant procedure, whereby the procedure-related risk for the patients is reduced, since the complication rate during a pacemaker-like approach of automatic cardioverter/ defibrillator implantation' 5 ' is lower than that with transvenous automatic cardioverter/defibrillator im-plantation, with the need to create an abdominal pocket and with the necessity of general anaesthesia (complication rate between 2-9% [l] and 6% [2]). Furthermore , the time interval from the automatic cardioverter/ defibrillator implantation to the patient's discharge from hospital is reduced' 51 , resulting in lower costs for treatment. Thus, the pacemaker-like automatic cardioverter/defibrillator implantation mode is a very promising approach in the treatment of malignant ventricular arrhythmias. However, it has to be considered that the groups' 4 ' 51 who have reported their excellent results included highly trained electrophysi-ologists who were also experienced in pacemaker implantation. Implantation of an automatic cardioverter/ defibrillator improves the survival of patients at risk of sudden cardiac death, even if the arrhythmia cannot be induced whilst they are taking drugs' 61. If the further experience of other groups confirms the feasibility and safety of this pacemaker-like implan-tation approach, we may see an expansion of the indication for automatic cardioverter/defibrillator implantation in patients who are at risk of sudden cardiac death without previous serial drug testing. A simplified, single-lead unipolar transvenous cardioversion-defibrillation system. For over 50 years, evaluation of the electrocardio-graphic ST segment response to exercise performed on stairs, bicycle or treadmill has been the most widely used laboratory method for the evaluation of ischaemic heart disease. The test is now applied for the identification of coronary disease in general populations, for the assessment of the anatomical and functional severity of established disease, for the evaluation of effort tolerance, for serial evaluation following therapeutic intervention and for the prediction of cardiovascular risk in selected populations. However, the traditional exercise test has important and well recognized limitations. When an abnormal electrocardiographic response is defined by an empirically derived criterion of 0-1 mV of horizontal or down-sloping ST depression, test sensitivity for the detection of coronary disease is generally low, particularly in patients with only modestly severe obstruction, even though test specificity is quite high when patients with otherwise clinically recognized hypertensive, valvular and myopathic disease are excluded. As an inevitable mathematical consequence of these test performance …