[A new method of recording spike potentials of the atria from the body surface]. / Eine neue Registriermethode von Spike-Potentialen der Vorhöfe von der Körperoberfläche.

A new method of recording spike potentials (rapid deflections) of the heart conductive system (sinus node, atrial conductive tracts, His' bundle)from the body surface was developed using differential magnifying 50 to 250 times and yielding frequencies 30-110 Hz with special filters. The curves with differentially amplified spike potentials (DASP) of the heart conductive system were recorded in 249 patients with various cardiac arrhythmias; the control group consisted of 60 healthy persons. By means of synchronous recording of intracardiac ECG and DASP curves on the latter well recognizable points for the determination of the excitation spreading rate in certain areas of the conductive system were distinguished. The recording of DASP-curves allowed the determination of intraatrial conduction disturbances, atrial overloading and distinguishing of retrograde conduction in atria, sinoventricular conduction, ectopic prefibrillatory activity and differentiation of paroxysmal tachycardias. The new method of recording of spike potentials of the atria from the body surface allows the diagnosis of the conduction disturbances and cardiac arrhythmias, including life threatening ones, which were previously determined using exclusively intracardiac ECG. The application of our method enables to increase the possibilities of the investigation of cardiac arrhythmias and conductive disturbances and allows a multiple examination and evaluation of the influence of drugs on the heart conductive system.

[Significance of spike potentials in the sinus nodes and atrial conduction system during interpretation of bundle-of-his electrography]. / Zur Bedeutung der Spike-Potentiale des Sinusknotens und des Vorhofsleitungssystems bei der Interpretation der His-Bündel-Elektrographie

The article deals with the issues of the His bundle electrogram (HBE) analysis, using the spike potentials of the sinus node and the atrial conductive tracts for the interpretation of the HBE. The HBE and the atrium spike potentials have been recorded in 40 dogs and in 307 patients. According to our data the onset of the A-wave on the IcECG begins in some msec earlier than the onset of the P-wave on the standard ECG leads. The spike potentials of the sinus node have been recorded directly at the sinus node area, the onset of which begins in 20-40 msec earlier than the onset of the P-wave. By our data the atrial A-wave recorded from the right atrium on the IcECG consists of the slow wave showing summary effect of the atrium depolarization and the three spikes (A1, A2, A3). They are recorded at the beginning (A1) middle (A2) and the end (A3) of the P-wave and reflect the quick impulse spread through the atrium conductive tracts. The moment of the impulse coming to the AV nodes is reflected by the atrial spike A2. The time of the impulse spread from the sinus node to the AV node shows exactly the interval from the onset of the spike potential of the sinus node till the spike A2. The interval from the spike A2 to the H-potential (A2-H) shows the impulse spread time through the AV node. The recording of the HBE and the atrium spike potentials was performed by means of the microcatheter of own construction (with the unipolar electrodes, external diameter of which does not exceed 1 mm) after our method of the heart microcatheterization through the subclavian vein.

[Method of recording the diagnostic value of the electrocardiograph of the bundle of His]. / Metod registratsii i diagnosticheskaia tsennost' elektrogrammy puchka Gisa

A method of cardiac microcatheterization introduced by the authors and effected by puncturing the left subclavian vein with a microcatheter of their original design permits recording the bundle of His electrogramme in a functional diagnosis study or in an intensive care ward. The bundle of His electrogramme was recorded in 107 patients, 72 of them having ischaemic heart disease, and 35 -- other cardiac lesions. The obtained data support the high diagnostic value of the bundle of His electrogramme, especially in determining the level of the atrioventricular block, of the reentry phenomenon, in differentiating abberant QRS complexes from ventricular extrasystoles, in diagnosing ectopic rhythms from different parts of the conductive system of the heart, and other complicated arrhythmias. The bundle of His electrogramme can be also used for the study of the effect of drugs on the conductivity function.

Recording of spike potentials of heart atria and His bundle using microcatheterization via subclavian vein.

The authors describe their own method of right heart microcatheterization by means of transcutaneous introduction of an original unipolar microcatheter into the left subclavian vein. The method makes possible recording of th His bundle electrogram as well as of spike potentials of the sinus node and atrial conduction pathways. His bundle electrograms were recorded in 237 subjects, of whom 72 had ischaemic heart disease and 115 suffered from other cardiopathies, 50 persons with non-cardiac diseases constituted the control group. The high diagnostic value of His bundle electrogram was confirmed, especially in appraising the degree of A-V block, differentiation between aberrant QRS complexes and ventricular extrasystolia, and in other arrhythmias. Recording of spike potentials of the sinus node, atrial conduction pathways, and His bundle, and determination of the interposed intervals allow selective assessments of the impulse propagation velocities in individual segments of heart conduction system, especially on drug administration, and offer valuable information on the genesis of various types of arrhythmias and conduction disturbances.