Noninvasive recording of electrical activity in the PR segment in man.

Vincent, R.; Stroud, Nicole; Jenner, Raimundo; English, M.J.; Woollons, D J; Chamberlain, Douglas

doi:10.1136/hrt.40.2.124

Cited by 41 publications

(24 citation statements)

References 11 publications

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“…The improvement of the signal to noise ratio is primarily dependent upon the number of cycles summed (Berbari et al, 1973;Flowers and Gurbachan, 1979;Perry and Childers, 1969;Ros et al, 1975;Vincent et al, 1978Vincent et al, , 1980 and is proportional to the square root of the number of cycles averaged, e.g., by the factor of 10 when 100 cycles are averaged.…”

Section: Principles Of the Signal Averaging Techniquementioning

confidence: 99%

“…Following these earlier studies, three independent groups, Berbari et al (1973), Flowers et al (1973);and Stopczyk et al (1973) reported their initial experiences on surface His bundle recordings by signal averaging. Since that time numerous investigators have applied this technique to obtain noninvasive His bundle potentials from the body surface (Furness et al, 1975;Hishimoto and Sawayama, 1975;Honda et al, 1977;McKenna et al, 1979;Pernod et al, 1977; al., 1975;Takeda et al, 1979;Van den Akker et al, 1976;Vincent et al, 1978Vincent et al, , 1980Wajszczuk et al, 1978). In contrast to these discontinuous registrations by sampling and averaging hundreds of cardiac cycles, Trethewie (1975) tried to receive surface His bundle potentials from his leads A, B, and C by proper filtering and lowlevel amplifying . In 1977 we could demonstrate that during simultaneous registrations of intracardiac and surface His bundle potentials obtained by Trethewie's method, the surface His bundle signals corresponded to the intracardiac ones in about 60% of cases (Hombach et al, 1977b).…”

Section: Introductionmentioning

confidence: 99%

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The applicability of the signal averaging technique in clinical cardiology

Hombach

Braun

Höpp

et al. 1982

Clinical Cardiology

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Summary:Since 1963 the signal averaging technique has been applied to improve the signal to noise ratio in highly amplified EKG registrations. Based on the experiences from the literature and the authors own laboratory, the applications of the signal averaging technique in clinical cardiology are reviewed: extraction and analysis of the fetal EKG and P-wave variations, His bundle electrograms from the body surface (recovery rate 33-100% of cases), ventricular delayed depolarizations within the ST segment of the surface EKG (recovery rate, 40-90% of cases, depending on patient groups investigated), preatrial activity (sinus nodal potentials) from intracardiac (recovery rate, 80-90% of individuals), or surface EKGs (recovery rate, 60% of patients), analysis of frequency components of surface EKG-QRS complexes in patients with previous myocardial infarctions, and detection of low amplitude diastolic signals from surface phonocardiogram (recovery rate, 80% of cases). At present, advantages and limitations of the signal averaging technique may be appraised as follows: ( 1 ) sinus nodal potentials: S-A conduction times may be more reliable than those obtained by the extra-stimulus technique, since with averaging they are recorded during undisturbed sinus rhythm; direct recordings of changing S-A blocks may be impossible due to the summation process; validation of sinus nodal potentials in man necessary, (2) A-V nodal potentials: demonstration of true A-V nodal rhythm rather than His bundle rhythm; possibly direct identification of abnormal pathways in A-V nodal tachycardias; direct recordings of single A-V nodal blocks impossible due to summation process; (3) surface His bundle potentials: follow-up or screening of patients with A-V nodal and particularly His-Purkinje-system blocks; monitoring of antiarrhythmic drug therapy; atrial overlap in one-third of cases; direct identification of higher degree A-V nodal blocks impossible due to summation process (future developments may overcome this problem); (4) ventricular delayed depolarizations: possible identification of patients at high risk of sudden cardiac death; follow-up of therapeutic measures like antiarrhythmic drug therapy or cardiac surgery (bypass grafting, aneurysmectomy); validation of delayed depolarizations from body surface by direct intracardiac and/or epicardial mapping necessary.

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Section: Principles Of the Signal Averaging Techniquementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The applicability of the signal averaging technique in clinical cardiology

Hombach

Braun

Höpp

et al. 1982

Clinical Cardiology

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“…High-resolution, signal-processed electrocardiography has previously been shown to be practical in adults [4,7,11,13,17,20,23] for both the detection of His bundle potentials [7,11,13,17,20,23] and in some patients for the identification of ventricular late potentials [4,11,19] . Its use in infants has not been previously described .…”

Section: Discussionmentioning

confidence: 99%

Noninvasive recording of the His bundle electrogram in neonates

et al. 1984

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Twenty-seven normal, nonsedated neonates had high-resolution electrocardiography performed during the first four days of life. Using high amplification, analogue and digital filters, and signal averaging, easily defined His bundle deflections of 0.75-7.75 (mean 2.5) microV were detected in 25 (92.6%) of the 27 babies. The PH interval was 60-105 (mean 83) ms and the HV interval 10-25 (mean 17) ms. Surface His bundle electrocardiography is easily performed in the neonate and, as might be predicted, conduction intervals are considerably shorter than those seen in older age groups.

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“…A noninvasive method has been introduced recently to record surface electrical activity within the PR segment of the conventional electrocardiogram, which is synchronous with the His-bundle potential recorded through an intracardiac electrode (Berbari ef af., 1973;Berry et al, 1974;Flowers et al, 1974;Furness et al, 1975;Hishimoto and Sawayama, 1975;Vincent et al, 1978;Wajszcuk et al, 1978). The technique is based on high-gain amplification of the electrical signals within the PR segment obtained through the surface electrodes, and the exclusion of random noise by employment of high-and low-pass band filters.…”

Section: Introductionmentioning

confidence: 99%

Clinical evaluation of his‐bundle electrogram recorded from the body surface

Feyter

Ros

Majid

et al. 1981

Clinical Cardiology

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Summary: A noninvasive method of recording His-bundle activity was developed in our laboratory. This technique is based on the principle of high-gain amplification of the external signals, use of appropriate filters to eliminate random noise, and averaging of the amplified signals over 200-500 cardiac cycles to improve the signal-to-noise ratio.Using this technique we were able to demonstrate external His-bundle activity and to measure the external His-bundle-ventricular (H-V) interval in 29 of 51 (60%) patients referred to our unit for evaluation of conduction abnormalities or history of collapse. The external technique was validated by the intracardiac electrode method. External H-V interval was reproducible when tested in eight normal subjects and four patients at three different time intervals (average coefficient of variation was 4.5% for external H-V interval of 30-90 ms duration).Failure to obtain distinct external His-bundle deflection was largely due to contamination with atrial or ventricular noise. Analysis of all the records showed that the demonstration of external His-bundle activity was directly proportional to the length of the PR segment. The external H-V interval could be measured in all patients with PR segments longer than 100 ms but in less than half of patients in whom the PR segment was shorter than 55 ms.We conclude that the noninvasive technique of recording His-bundle activity is simple and reproducible and can be used at the bedside. It possesses a distinct advantage over the intracardiac technique in that it can be employed in sequential studies. However, in its present state of development, its use is mainly confined to the analysis of conduction disturbances.

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Noninvasive recording of electrical activity in the PR segment in man.

Cited by 41 publications

References 11 publications

The applicability of the signal averaging technique in clinical cardiology

The applicability of the signal averaging technique in clinical cardiology

Noninvasive recording of the His bundle electrogram in neonates

Clinical evaluation of his‐bundle electrogram recorded from the body surface

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