Takeda H, Kitamura K, Takanashi T, Tokuoka T, Hamamoto H, Katoh T, Niki I, Hishimoto Y
Circulation. 1979 Aug;60(2):421-6. doi: 10.1161/01.cir.60.2.421.
In seven patients with complete atrioventricular (AV) block, His bundle electrograms (HBEs), standard ECG recordings, bipolar esophageal ECGs and highly amplified, filtered, bipolar chest lead ECGs were simultaneously recorded. The filtered chest lead ECG was averaged to determine His-Purkinje activity (HPA). A simplified device, the "automated discrimination circuit," was used to selectively eliminate the superimposed atrial and ventricular potentials that are characteristic of complete AV block and unsuitable for signal averaging. The processed chest lead ECG was amenable to conventional techniques of signal averaging. In four patients with block proximal to the AV node diagnosed by HBE, there was no activity after the P wave in the surface-averaged ECGs. HPA was consistently recorded before the QRS in the surface-averaged ECG. The measurements of the HV and HPA-V intervals were very close, with a difference of less than 2 msec. Three patients with block distal to the His bundle by HBE showed a loss of electrical potential before the QRS in the surface-averaged ECG, but had a consistent HPA after the P waves. The P-HPA intervals coincided well with PH intervals, with a maximal difference of 5 msec.
在7例完全性房室（AV）传导阻滞患者中，同时记录希氏束电图（HBE）、标准心电图记录、双极食管心电图以及高度放大、滤波后的双极胸导联心电图。对滤波后的胸导联心电图进行平均处理以确定希氏-浦肯野系统活动（HPA）。使用一种简化装置“自动鉴别电路”，选择性地消除完全性AV传导阻滞所特有的、不适合信号平均处理的叠加心房和心室电位。处理后的胸导联心电图适用于传统的信号平均技术。在4例经HBE诊断为房室结近端阻滞的患者中，体表平均心电图在P波之后无活动。在体表平均心电图中，HPA始终在QRS波之前记录到。HV间期和HPA-V间期的测量值非常接近，差值小于2毫秒。3例经HBE诊断为希氏束远端阻滞的患者，体表平均心电图在QRS波之前出现电位丧失，但在P波之后有一致的HPA。P-HPA间期与PH间期吻合良好，最大差值为5毫秒。
