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Download Textbook of Clinical Electrocardiography by A. Bayés de Luna (auth.) PDF

By A. Bayés de Luna (auth.)

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Sample text

3 The domino theory [26J (Fig. 1-37) It is necessary to understand how the impulse origi- nated in the sinus node, the structure with the greatest automaticity, is successively propagated to the atrial myocardium, A-V node (the next most automatic structure after the sinus node, although this is normally not apparent because the sinus impulse depolarizes it), specialized intraventricular conduction system and finally, the ventricular myocardium. When the ventricles are totally depolarized, ventricular repolarization begins.

1-26). Recently, His bundle activity has been recorded with sophisticated external methods of ampliation, filtering and averaging of signals [12]. 5-2 m/sec) (Fig. 1-12). It is presently admitted that the intraventricular conduction system has three terminal divisions, trifascicular theory (Fig. 1-1), the right branch representing one division, the superoanterior and inferoposterior divisions of the left branch, true anatomic fascicles, being the other two. The importance of these two divisions has been demonstrated by Rosenbaum and collegues [22].

As the wave advances, it leaves behind a wake of negative charges throughout the zone where it has passed. The pair of charges (- +) , or dipole, can be considered the reflection of the depolarization wave. i. electrode A; Fig. 1-13) (regardless of whether the dipole is going towards the electrode or away from it) , and negative potentials at the points facing the negative pole of the dipole, or tail of the vector (also regardless of the sense of its movement) (Fig. 1-13). The points that face the positive charge of the dipole first, and then its negative charge, record a positive-negative deflection, that is, a diphasic deflection.

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