Waldo A L, Maclean A H, Karp R B, Kouchoukos N T, James T N
Br Heart J. 1977 Jun;39(6):634-40. doi: 10.1136/hrt.39.6.634.
Studies were performed in 6 patients during open heart surgery to correlate the relative sequence of atrial activation with the polarity of the retrograde P wave in electrocardiographic leads II, III, and aVF. Bipolar atrial electrograms were recorded from selected sites during threshold pacing from sites low on the right side of the atrial septum which when paced resulted in the inscription of either negative or positive P waves in electrocardiograph leads II, III, and aVF. When the atria were paced from a site just anterior to the coronary sinus ostium (negative P waves), the posteroinferior left atrium was activated early and Bachmann's bundle late during the inscription of the P wave. When the atria were paced from a site 2 cm anterior to the coronary sinus ostial site (positive P waves), Bachmann's bundle was activated early during the P wave and the posteroinferior left atrium was activated relatively later. These data from man are consistent with previous studies in the canine heart. Therefore, we deduced that in man during the inscription of negative retrograde P waves in leads II, III, and aVF, atrial activation occurs primarily in a retrograde fashion. However, during the inscription of positive retrograde P waves in man, activation occurs rapidly up the interatrial septum (we believe via the anterior internodal pathway) to Bachmann's bundle, from where it then spreads in a manner similar to that which occurs during normal sinus rhythm.
对6例接受心脏直视手术的患者进行了研究，以关联心房激动的相对顺序与心电图II、III和aVF导联中逆行P波的极性。在从房间隔右侧低位部位进行阈值起搏期间，从选定部位记录双极心房电图，该部位起搏时会在心电图II、III和aVF导联中记录到负向或正向P波。当从冠状窦口前方紧邻的部位起搏心房时（负向P波），在P波记录期间，左心房后下壁早期被激动，而Bachmann束晚期被激动。当从冠状窦口部位前方2 cm处起搏心房时（正向P波），Bachmann束在P波期间早期被激动，而左心房后下壁相对较晚被激动。来自人体的这些数据与先前在犬心脏中的研究一致。因此，我们推断，在人体心电图II、III和aVF导联记录到负向逆行P波期间，心房激动主要以逆行方式发生。然而，在人体记录到正向逆行P波期间，激动沿房间隔迅速向上（我们认为是通过前结间通路）到达Bachmann束，然后从该部位以类似于正常窦性心律时的方式传播。
