Letters to the Editor Ambulatory
ECG recording
To the Editor: I enjoyed the article by Dr. Israel M. Stein, in your July, 1974, issue, entitled “Ambulatory long-term electrpcardiography-the ‘LCG’ ” (AM. HEART J. 88:37, 1974). From this brief literature review, it is apparent that Dr. Stein has joined a distinguished and rapidly increasing list of investigators and clinicians who have discovered the wide spectrum of uses of ambulatory ECG recording. I applaud his enthusiasm for the technique. However, I feel strongly that his newly-coined reference to the technique as “LCG” is both unnecessary and confusing. Since the introduction by Norman J. Holter in 1957 of a diagnostic technique for continuously recording an ambulatory patient’s electrocardiogram with subsequent high speed analysis of the resulting recording, a variety of terminology has been used in the literature to describe the procedure. Depending on the time and geographic location, papers have referred to the technique as radiocardiography, radiotelecardiography, storage telemetry, long-term continuous electrocardiography, dynamic electrocardiography, Holter electrocardiography, Holter monitoring, and Holter recording. I submit that by far the most commonly used names for the procedure are “Holter ECG” and “Holter recording.” These would seem to be the most appropriate generic names regardless of the specific apparatus employed. This is particularly relevant since some of the other terminologies have been embraced by particular instrument manufacturers. By adopting the term “Halter ECG” we also preserve a tradition in science by honoring the inventor of the technique. It should also be pointed out that Dr. Stein footnotes his comment that “several devices are available commercialsources: ly . . .I’ with the names of three equipment Avionics, Medcraft, and Dr. Stein’s own Clinical Data Services (Helega recorder). In fact, there are at least three other manufacturers of recording equipment for Holter electrocardiography which include Oxford Instruments, Annapolis, Md., Siemens, Erlangen, West Germany, and CardioDynamics Laboratories, Inc., Beverly Hills, Calif. Joseph J. Sheppard, PhD., President Cardio-Dynamics Laboratories, Inc. 8454 Wilshire Blvd. Beverly Hills, Calif 90212
1. Holter, N. J.: Radioelectrocardiography: A new technique for cardiovascular studies, N. Y. Acad. Sci. 65:913, 1967.
Reply To the Editor: I wish to thank Dr. Sheppard for his comments. I agree with Dr. Sheppard that a variety of terminology has been used in the literature to describe this procedure, and that no generic term has been formally adopted. Current trends do not favor the use of eponyms, as will be noted in several editorials recently ‘published. A much more favorable approach is the use of descriptive terminology. Therefore I suggest that the expression “long-term ECG” be used to identify this technique. It is perhaps of further interest that the original patent describing the long-term ECG procedure bears the names of the two co-inventors, Holter and Glasscock. With respect to the delineation of the manufacturers of
406
available equipment for the performance of the long-term ECG, the listing in the article was by no means meant to be a complete one. Indeed, several other devices are available aside from the additional ones mentioned by Dr. Sheppard in his letter. Parenthetically, the tape recorder used by Clinical Data is made to our exclusive specifications by a Swedish manufacturer and is not derived from the Helige Company. Israel M. S&in, hi. D. Medical Director Clinical Data, Inc. 358 Chestnut Hill Ave. Boston, Mass. 02146
Editorial: Descrimination in Eponymdom, J.A.M.A. 218:1093, 1971. Oren, B. G.: Eponymania, N. Engl. J. Med. 29Ck524, 1974. Cross, H. E.: The use and abuse of eponyms, Am. J. Ophthalmol. 76:598, 1973. Holter, N. J., and Glasscock, W. R.: Electrocardio recording and reproducing system, U.S. Patent 3,229, 887, Jan. 18, 1966.
Ventricular
function curves
To the Editor: In a recent article entitled, “Ventricular function curves from the cardiac response to angiographic contrast: A sensitive detector of ventricular dysfunction in coronary artery disease” (Brundage and Cheitlin: AM. HEART J. 88:281,19741, there seems to be some confusion in the usage of the terms “compliance” and “stiffness” of the left ventricle. Under Methods the authors defined “compliance” as APIAV which in fact represents “stiifness.” Compliance is the reciprocal of stiffness. Under Results the authors described a significant decrease in compliance after angiogram in Group B which was, however, depicted in Table I as an increase in APIAV from the pre-angiogram value of 0.29 to 0.42 after angiogram. Twig 0. Cheng, M.D. The George Washington Universi@ Medical Center 2150 Pennsylvania Ave., NW Washington, D.C. 20087
Reply To the Editor: Dr. Cheng is quite correct in his definitions of “compliance” and “stiffness.” We should have defined APIAV as “stiffness,” and not “compliance” in our methods. However, in our discussion of the results we were consistent in implying that ventricles with coronary artery disease were more stiff-i.e., less compliant than normal ventricles both before and after angiogram. This was represented by higher values of APIAV in Table I for the ventricles with coronary artery disease. The terms compliance and stiffness are analogous to the vintner describing a wine as “more dry” or “less sweet.” Bruce H. Bruno!oge, M.D., LTC, MC Cardiology Service Fitssimons Army Medical Center Denver, Colo. 80240
March,
1975, Vol. 89, No. 3
ECG recording
To the Editor: I enjoyed the article by Dr. Israel M. Stein, in your July, 1974, issue, entitled “Ambulatory long-term electrpcardiography-the ‘LCG’ ” (AM. HEART J. 88:37, 1974). From this brief literature review, it is apparent that Dr. Stein has joined a distinguished and rapidly increasing list of investigators and clinicians who have discovered the wide spectrum of uses of ambulatory ECG recording. I applaud his enthusiasm for the technique. However, I feel strongly that his newly-coined reference to the technique as “LCG” is both unnecessary and confusing. Since the introduction by Norman J. Holter in 1957 of a diagnostic technique for continuously recording an ambulatory patient’s electrocardiogram with subsequent high speed analysis of the resulting recording, a variety of terminology has been used in the literature to describe the procedure. Depending on the time and geographic location, papers have referred to the technique as radiocardiography, radiotelecardiography, storage telemetry, long-term continuous electrocardiography, dynamic electrocardiography, Holter electrocardiography, Holter monitoring, and Holter recording. I submit that by far the most commonly used names for the procedure are “Holter ECG” and “Holter recording.” These would seem to be the most appropriate generic names regardless of the specific apparatus employed. This is particularly relevant since some of the other terminologies have been embraced by particular instrument manufacturers. By adopting the term “Halter ECG” we also preserve a tradition in science by honoring the inventor of the technique. It should also be pointed out that Dr. Stein footnotes his comment that “several devices are available commercialsources: ly . . .I’ with the names of three equipment Avionics, Medcraft, and Dr. Stein’s own Clinical Data Services (Helega recorder). In fact, there are at least three other manufacturers of recording equipment for Holter electrocardiography which include Oxford Instruments, Annapolis, Md., Siemens, Erlangen, West Germany, and CardioDynamics Laboratories, Inc., Beverly Hills, Calif. Joseph J. Sheppard, PhD., President Cardio-Dynamics Laboratories, Inc. 8454 Wilshire Blvd. Beverly Hills, Calif 90212
1. Holter, N. J.: Radioelectrocardiography: A new technique for cardiovascular studies, N. Y. Acad. Sci. 65:913, 1967.
Reply To the Editor: I wish to thank Dr. Sheppard for his comments. I agree with Dr. Sheppard that a variety of terminology has been used in the literature to describe this procedure, and that no generic term has been formally adopted. Current trends do not favor the use of eponyms, as will be noted in several editorials recently ‘published. A much more favorable approach is the use of descriptive terminology. Therefore I suggest that the expression “long-term ECG” be used to identify this technique. It is perhaps of further interest that the original patent describing the long-term ECG procedure bears the names of the two co-inventors, Holter and Glasscock. With respect to the delineation of the manufacturers of
406
available equipment for the performance of the long-term ECG, the listing in the article was by no means meant to be a complete one. Indeed, several other devices are available aside from the additional ones mentioned by Dr. Sheppard in his letter. Parenthetically, the tape recorder used by Clinical Data is made to our exclusive specifications by a Swedish manufacturer and is not derived from the Helige Company. Israel M. S&in, hi. D. Medical Director Clinical Data, Inc. 358 Chestnut Hill Ave. Boston, Mass. 02146
Editorial: Descrimination in Eponymdom, J.A.M.A. 218:1093, 1971. Oren, B. G.: Eponymania, N. Engl. J. Med. 29Ck524, 1974. Cross, H. E.: The use and abuse of eponyms, Am. J. Ophthalmol. 76:598, 1973. Holter, N. J., and Glasscock, W. R.: Electrocardio recording and reproducing system, U.S. Patent 3,229, 887, Jan. 18, 1966.
Ventricular
function curves
To the Editor: In a recent article entitled, “Ventricular function curves from the cardiac response to angiographic contrast: A sensitive detector of ventricular dysfunction in coronary artery disease” (Brundage and Cheitlin: AM. HEART J. 88:281,19741, there seems to be some confusion in the usage of the terms “compliance” and “stiffness” of the left ventricle. Under Methods the authors defined “compliance” as APIAV which in fact represents “stiifness.” Compliance is the reciprocal of stiffness. Under Results the authors described a significant decrease in compliance after angiogram in Group B which was, however, depicted in Table I as an increase in APIAV from the pre-angiogram value of 0.29 to 0.42 after angiogram. Twig 0. Cheng, M.D. The George Washington Universi@ Medical Center 2150 Pennsylvania Ave., NW Washington, D.C. 20087
Reply To the Editor: Dr. Cheng is quite correct in his definitions of “compliance” and “stiffness.” We should have defined APIAV as “stiffness,” and not “compliance” in our methods. However, in our discussion of the results we were consistent in implying that ventricles with coronary artery disease were more stiff-i.e., less compliant than normal ventricles both before and after angiogram. This was represented by higher values of APIAV in Table I for the ventricles with coronary artery disease. The terms compliance and stiffness are analogous to the vintner describing a wine as “more dry” or “less sweet.” Bruce H. Bruno!oge, M.D., LTC, MC Cardiology Service Fitssimons Army Medical Center Denver, Colo. 80240
March,
1975, Vol. 89, No. 3
