Hariman R J, Krongrad E, Boxer R A, Weiss M B, Steeg C N, Hoffman B F
Am J Cardiol. 1980 Apr;45(4):775-81. doi: 10.1016/0002-9149(80)90121-6.
A method for recording electrical activity of the sinoatrial (S-A) node and automatic atrial foci in human subjects is described. To record S-A nodal electrograms, an electrode catheter was inserted percutaneously into the femoral vein and advanced under fluoroscopic control to the superior vena caval-right atrial junction. The distal terminal of the catheter was placed in the area of the S-A node and the proximal terminal on the free right atrial wall or in the right atrial lumen. Polarity was reversed from the conventional electrocardiographic recording; high amplification (about 100 microV/cm) and selective filters (0.1 to 20 hertz) were used. S-A nodal electrograms recorded with this method in human subjects were similar to electrograms obtained previously from the dog and rabbit and revealed negatively directed diastolic and upstroke slopes preceding the P wave of the electrocardiogram. Sinoatrial conduction time measured from the S-A nodal electrograms in 15 cases was 34.9 +/- 2.1 ms(mean +/- standard error of the mean) for a sinus cycle length of 736.4 +/- 38.6 ms. The coronary sinus electrograms in a patient with coronary sinus rhythm were recorded by the same technique except that the distal terminal of the catheter was placed at the coronary sinus ostium. A negatively directed diastolic slope preceding the P wave was consistently recorded. This method for recording electrograms of the S-A node and ectopic automatic atrial foci should prove useful in (1) assessment of both normal and abnormal S-A nodal function, (2) direct determination of conduction time from the S-A nodal pacemaker to the atrium, and (3) localization of automatic atrial foci.
本文描述了一种记录人体窦房结（S-A）和心房自动兴奋灶电活动的方法。为记录窦房结电图，将电极导管经皮插入股静脉，并在荧光镜控制下推进至上腔静脉-右心房交界处。导管远端置于窦房结区域，近端置于右心房游离壁或右心房腔内。极性与传统心电图记录相反；使用高放大倍数（约100微伏/厘米）和选择性滤波器（0.1至20赫兹）。用这种方法在人体记录的窦房结电图与先前从狗和兔子获得的电图相似，并显示出在心电图P波之前有负向的舒张期和上升斜率。在15例中，根据窦房结电图测得的窦房传导时间，对于736.4±38.6毫秒的窦性周期长度，为34.9±2.1毫秒（平均值±平均值的标准误差）。用相同技术记录了一例冠状窦节律患者的冠状窦电图，只是将导管远端置于冠状窦口。在P波之前始终记录到负向的舒张期斜率。这种记录窦房结和异位心房自动兴奋灶电图的方法在以下方面应被证明是有用的：（1）评估正常和异常的窦房结功能；（2）直接测定从窦房结起搏点到心房的传导时间；（3）定位心房自动兴奋灶。
