Shaw M, Niemann J T, Haskell R J, Rothstein R J, Laks M M
Am J Med. 1987 Apr;82(4):689-96. doi: 10.1016/0002-9343(87)90002-7.
Esophageal electrocardiography can detect atrial electrical activity during tachyarrhythmias when P waves are not evident by surface electrocardiography. However, patient discomfort, the difficulty of accurately interpreting cardiac signals against a background of electrical noise, and the complexity of use have limited widespread application. In this study, esophageal electrocardiography was used in 48 acutely ill patients with a new "pill electrode" system, consisting of a bipolar electrode pair (3 by 20 mm) attached to 0.5 mm diameter Teflon wires contained in a standard gelatin capsule. The capsule with enclosed electrodes was voluntarily swallowed, and the recording electrodes were positioned posterior to the left atrium. A preamplifier system with a low-frequency filter and a standard three-channel electrocardiographic recorder were used. Esophageal "pill" electrocardiographic recordings were made in 48 of 50 eligible study patients (96 percent) with tachyarrhythmias and absent or equivocal atrial activity on surface electrocardiography. In these patients, a high-quality esophageal electrocardiographic recording was obtained within one to 10 minutes with minimal patient discomfort. In 25 of 48 study patients (52 percent), the original diagnosis, based on the surface electrocardiographic recording, was incorrect after review of the esophageal recording. Results of esophageal recording altered management in 19 of 48 (40 percent) patients. This new and simple technique facilitates diagnosis and management of perplexing tachyarrhythmias in acutely ill patients by physicians with minimal training in the technique.
当体表心电图无法明确显示P波时，食管心电图可检测快速心律失常期间的心房电活动。然而，患者的不适感、在电噪声背景下准确解读心脏信号的困难以及使用的复杂性限制了其广泛应用。在本研究中，48例急性病患者使用了一种新型“药丸电极”系统进行食管心电图检查，该系统由一对双极电极（3×20mm）组成，附着于标准明胶胶囊内直径为0.5mm的聚四氟乙烯导线上。装有封闭电极的胶囊被患者自愿吞下，记录电极置于左心房后方。使用带有低频滤波器的前置放大器系统和标准的三通道心电图记录仪。50例符合条件的研究患者中有48例（96%）出现快速心律失常且体表心电图显示心房活动缺失或不明确，对这些患者进行了食管“药丸”心电图记录。在这些患者中，1至10分钟内即可获得高质量的食管心电图记录，且患者不适感最小。48例研究患者中有25例（52%），在回顾食管记录后发现基于体表心电图记录的初始诊断不正确。食管记录结果改变了48例患者中19例（40%）的治疗方案。这项新的简单技术有助于接受该技术最少培训的医生对急性病患者复杂的快速心律失常进行诊断和治疗。
