Noninvasive detection of bundle of his potential using esophageal to surface lead configuration

Abstract

A novel electrode system, custom amplifier design, and computerized data acquisition/analysis method for noninvasive His potential monitoring has been developed for use as a research tool. The theory and motivation responsible for this system design will be presented along with the actual design details and experimental results. Studies employing this experimental system have revealed distinct activity in the PR segment of the electrocardiogram (normally isoelectric with conventional ECG equipment) which corresponds to the activation of the Bundle of His. The noninvasively determined time interval between His excitation and the onset of ventricular activation (HV interval) in dogs was shown to be highly correlated with the simultaneously obtained interval on an intracardiac lead recording. Although a true His electrogram was not available for positive identification of the HV interval in our human study, previously published electrophysiologic data was used to gauge our results. The HV time that we recorded was reasonable, relative to published HV values in normal children of the same age group.