A dynamic electrical record of the pathway of human His bundle activation from surface mapping

L G Horan, N C Flowers, G S Sohi
1982 Circulation Research  
Body surface potential maps of human His bundle activity have been difficult to produce for two reasons: (1) The peak surface potentials are often less than 5 /iv, and (2) the simultaneous atrial repolarization potentials frequently exceed 100 /iv. We have therefore amplified surface signals 25 times the standard gain of 1000, and then removed by cross-correlation the static pattern of atrial repolarization for serial 1-msec maps of the P-R segment in five normal men. A consistent finding
more » ... d: a positive anterior chest peak appeared 40 msec before QRS onset, and then-within 10 msec-spread out into a long, low transverse mound before disappearing in 5 more msec. The map data were analytically converted to serial electrical sources: the center of electrical activity moved first slightly down, then directly forward, before retracing its path and disappearing. The retrace and accompanying surface spread-out strongly suggests diverging dipolar sources. Thus the data fit a simple heart source which moves anteriorly and then breaks into two (right and left)-as expected from activation of the bundle of His and its bifurcation into left and right bundle branches. Circ Res 50:
doi:10.1161/01.res.50.1.47 pmid:7053877 fatcat:nv3ctfst6zgvpcxhixrdrdnfje