Bagliani Giuseppe, Leonelli Fabio, Padeletti Luigi
Arrhythmology Unit, Cardiology Department, Foligno General Hospital, Via Massimo Arcamone, 06034 Foligno (PG), Italy; Cardiovascular Diseases Department, University of Perugia, Piazza Menghini 1, 06129 Perugia, Italy.
Cardiology Department James A. Haley Veterans' Hospital, University South Florida, 13000 Bruce B Down Boulevard, Tampa, FL 33612, USA.
Card Electrophysiol Clin. 2017 Sep;9(3):365-382. doi: 10.1016/j.ccep.2017.05.001.
The sinus node is the primary cardiac pacemaker from which the wavefront of activation proceeds through bundles of atrial fibers to the atrioventricular node. Left atrial activation proceeds along the Bachmann bundle and lower right atrium, determining P-wave morphology. Electrocardiogram reveals ectopic or retrograde atrial activation, wandering pacemaker activity, or artificial pacemaker-mediated atrial depolarization. Vectorcardiography and transesophageal recording are complementary methods. Atrial anatomic structure and automatic cells outside the sinus node constitute the mechanisms of focal and reentrant atrial arrhythmias. Arrhythmias with specific arrhythmogenic mechanisms correspond to precise electrocardiographic morphology for accurate diagnosis.
窦房结是心脏的主要起搏点，激动波前由此通过心房纤维束传导至房室结。左心房激动沿巴赫曼束和右心房下部传导，决定P波形态。心电图显示异位或逆行心房激动、游走起搏点活动或人工起搏器介导的心房去极化。向量心电图和经食管记录是互补的方法。心房的解剖结构和窦房结以外的自律细胞构成局灶性和折返性房性心律失常的机制。具有特定致心律失常机制的心律失常对应于精确的心电图形态，以进行准确诊断。
