原著

Original Article

Esophageal lead enabled easily to identify auricular complex of orthodirectional or reciprocal nature; shape and intrinsicoid deflection were distinctly different from each other, but the directions of the auricular complexes did not always appear reversely. d. In one case with posterior infarction complicated by complete a-v block, the routine 12 leads did not strikingly show P waves, whereas by means of esophageal lead which was performed cautiously enabled to recognize the distinct P wave, therefore the interauricular dissociation was excluded with any difficulties. e. Esophageal leads of 9 cases with auricular fibrillation were studied at 9 times. In 2 of 9 cases f wave were seen more easily in V_1 than in esophageal lead, in 6 of all in the latter than in the former. f. In auricular flutter, esophageal lead enabled to disclose F waves regularly and to measure intrinsicoid deflection exactly.

Esophagoelectrocardiographically 86 observations about 78 cases with valvular diseases, hypertension, chronic cor pulmonale, cardiac infarction, bundle branch block, Wolff-Parkinson. White syndrome including various sorts of arrhythmias were performed in order to study the forms of auricular and ventricular complexes, the intermediary zone, the intrinsicoid deflection and auricular and ventricular conduction times. The ages of patients ranged between 15 and 78. 1. Auricular complex a. Form: In normal health W or N shape was seen. Among the patients N or N+W shape was also chiefly observed (73%) regardless of the sorts of diseases. There could not be found any pathognostic pattern. b. Q_a (auricular Q) could not be seen in 2 cases with mitral valvular disease, 1 with posterior infarction, and 3 with bundle branch block. As to mitral valvular disease, there were used to be found larger amplitudes of Q_a in the cases dominantly with stenosis than in those dominantly with insufficiency. In hypertension the contour of Q_a had no correlation to, the degree of Keith-Wagener's classification. The hypertensive patients who showed P-sinistrocardiale or its marked tendency had Q_a of large amplitude as well as the cases with mitral valvular disease. On the contrary among 2 cases with P-dextrocardiale the one showed Q_a of normal amplitude, the other that beyond normal limits. The voltage of Q_a ranged within normal range in all but each one case with posterior infarction, W.P.W. syndrome, and dextrocardia (above 0.1 mV). c. R_a (auricular R) showed larger amplitude roughly, in proportion to the degree of stenosis in mitral valvular disease. The large amplitude was also seen in the hypertensive cases with P-sinistrocardiale or its marked tendency as well as in the patients With mitral valvular disease. However no correlation could be found between amplitude of R_a and grading of Keith-Wagener's classification.

The supernormal R_a was often seen also in the cases with bronchial asthma and emphysema thoracis, or with anterior .infarction. d. Sa (auricular S) of large amplitude was more frequently observed in the cases dominantly with stenosis than in the patients dominantly with insufficiency as to mitral valvular disease. In hypertension as well as in mitral valvular disease, one case with the marked tendency of P-sinistrocardiale showed S_a of large amplitude. No correlation between amplitude of R_a and grading of Keith-Wagener's classification. There could be also seen the tendency of large S_a in one case with bronchial asthma and emphysema thoracis. e. Amplitude of P_e in mitral stenosis or mitral steno-insufficiency was larger than that in normal health, and that in mitral insufficiency was nearly within normal limits. The amplitude of P_e in hypertension except for 2 cases with P-sinistrocardiale was above the normal limits in average. No correlation to the grading of Keith-Wagener's classification. The amplitude of P_e in anterior infarction showed also the tendency to be above the normal range. The amplitude of P_e in left bundle branch block tended to be smaller than in Wilson block, although the case number was scanty and the range of change was within normal limits. f. Intrinsicoid deflection: In mitral valvular disease the striking delay could be seen; the delay found in the group dominantly with insufficiency tended to be rather larger. 7 cases with P-sinistrocardiale, except for one case, showed the intrinsicoid deflection above 0.06". Despite of no marked P in standard or chest leads, the definite delay could be observed in each one case with paroxysmal auricular flutter, paroxysmal auricular fibrillation and rheumatic endocarditis. No correlation between amplitude of P_e and its intrinsicoid deflection.

Except for one patient with dextrocardia the intrinsicoid deflection, in general, tended to delay in other diseases; but in hypertension there was no correlation between degree of the delay and grading of Keith-Wagener's classification, in bundle branch block there was no difference of the mode between Wilson and L. B. B. B. g. Intermediary zone was most frequently seen at E_<29>〜E_<37> (above 80 %), however in mitral valvular disease it was also observed at the more shallow spots i. e. at E_<25>〜E_<29> than in aortic or pulmonary valvular disease. In the cases with L. B. B. B., although the case number was scanty, all QRS directed upward so that the intermediary zone could not be seen. In W. P. W. syndrome occasionally the intermediary zone was observed at the relatively shallow spots, i. e. at E_<27>〜E_<31>. h. P_e .duration : At the leading spots above the auricle P_e was larger than P_<II> especially in the cases with myocardial infarction, aortic valvular disease, whereas commonly P_e≦P_<II> in the hypertensive cases. At the leading spots corresponding to the auricular level, regardless of the kinds of disorders, mostly P_<II>≦P_e. At the leading spots of ventricle, generally P_<II><P_e, especially in posterior myocardial infarction, aortic valvular disease, and kyphoscoliosis, whereas in the most of hypertensive cases P_<II>≧P_e. i. P_eQ_e duration: A lot of number of hypertensive cases showed PQ_<II>≧P_eQ_e at the upper auricular level, whereas at the auricular. level, 50 % of the patients showed PQi_<II><P_eQ_e, the rest of them PQ<II>=P_eQ_e or PQ<II>>P_eQ_e equally in number. At the ventricular level, 50 % of the hypertensive cases showed PQ<II>=P_eQ_e, or PQ<II>>P_eQ_e equally in number. 2. Ventricular complex a. Type: In normal health [Qr], [QS], and [rSr'] types were found. at the upper e-sophageal level, [qRs], [qR] and [Rs] types at the lower.