1 From the Cardiology Service, Division of Medicine and the Cardio-Thoracic Surgical Service, Division of Surgery, Montefiore Hospital and Medical Center, Bronx, New York.
In 25 cases at open heart surgery, atrial and ventricular close bipolar electrograms, an atrial unipolar electrogram, and a lead-II electrocardiogram were simultaneously monitored throughout each procedure. In six cases the ventricles or atria, or both, were paced by electrical stimulation. Although atrial activity could frequently not be clearly delineated on the lead II electrocardiogram, the time relationship between atrial and ventricular depolarization could at all times be determined from the electrograms. During ventricular premature beats and ventricular rhythms, retrograde A-V conduction and retrograde activation of the atria were common, and unidirectional retrograde A-V block was infrequent. In spontaneous and induced cardiac arrhythmias the fastest pacemaker of the heart, atrial, His bundle, or ventricular, usually activated the entire heart.
© 1967 American Heart Association, Inc.
The Dominant Pacemaker of the Human Heart
Antegrade and Retrograde Activation of the Heart
Key Words: Electrograms, atrial and ventricular • Ventricular rhythms • Atrioventricular conduction • Cardiac arrhythmias
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  B. N. GOLDREYER Intracardiac Electrocardiography in the Analysis and Understanding of Cardiac Arrhythmias Ann Intern Med, July 1, 1972; 77(1): 117 - 136. [Abstract] [PDF]
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