Noninvasive external recording of cardiac conduction system (His bundle) activity

Successful and adequate external recording of the cardiac conduction system from the body's surface can be accomplished in 80 to 90 percent of subjects studied. High-gain amplification, signal averaging, and triggering with a conditioned QRS signal results in good recording reproducibility. Averaging of 128 consecutive cycles is adequate, but on occasion averaging of 256 cycles may yield better results. The patients's QRS signal triggers the transfer of signals, which are digitized and stored during the preceding P-R interval. Comparison of external recordings with direct invasive recordings in animals and patients shows good correlation between the major His bundle deflections. The advantages of the system developed include its mobility, triggering the QRS with pretrigger data processing, and instantaneous display on Polaroid photograph. Future research should concentrate on further miniaturization and simplification of the instrumentation, detailed experimental comparison between direct and external recordings for identification of deflections and their origin, further study of the recording lead system, and the most appropriate method of information display.