The principles of esophageal electrocardiography

Document Type

Article

Publication Date

1-1-1959

Publication Title

American Heart Journal

Volume

57

Issue

1

Abstract

Our recent experiences with unipolar and bipolar esophageal leads have impressed us with the need for developing and clarifying the heart-lead relationships which apply to that particular area of clinical electrocardiography. Accordingly, we undertook such a study in the light of modern concepts, and report here the fundamental principles which were found to underlie esophageal electrocardiography. Largely on the basis of the lead-field and lead-vector concepts, together with a consideration of effects produced by the intracardiac phase-inhomogeneity, this study offers a rational explanation of why P waves appear in greatly amplified form in esophageal leads as compared to the relatively minor amplification of QRS complexes. The bipolar esophageal lead is shown to possess at least three unique properties, the latter two of which have already proved to be of special clinical value: (1) In the registration of atrial depolarization it is more truly a proximity lead than the unipolar connection. (2) In recording from the level of atrial transition it is strikingly sensitive to even minor variations in the time-course of atrial depolarization. (3) It greatly facilitates determination of the timing and direction of atrial activation in situations in which such information would ordinarily be obscured by the concomitant occurrence of ventricular depolarization. It is hoped that the theoretical principles developed here will eventually prove to be a reliable foundation for the clinical evaluation of present and future studies in esophageal electrocardiography. © 1959.

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