心房内刺戟傳導に關する實驗的研究(第4報) : 犬心房表面各部の刺戟伝達時間に就て
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In experiments with 10 dogs the author took direct lead E.C.G. simultaneously over the intra vena cava superior of its initial region and the atrial surface, and calculated the activation times at different points on the atrial surface, taking for the activation times to lead points what were expended between the initial point of the P wave led from the intra vena cava superior and where the intrinsic deflection of the P wave led from the atrial surface crosses the zoro-line. Then the author obtained the results that is showed in figure 1-4 and table I, and considered the formation of the stimulus conduction in the atrium in deference to these results. There are experiments of like nature by Lewis, Sodi-Pallares and others. However, as I found some points in their reports that I couldn't agree to, I have here brought about some comments on their opinion.The summary and conclusion of this study are as follows : 1) The initial stimulus point coincides with the anatomical region occupied by the head of the sinus node ; and the P wave in the unipolar lead E.C.G. led from that point is always found to be a negative wave of QS type.2) The activation values brought forth by the author for the different points on the atrial surface correspond to those of Sodi-Pallares. But the fact that the values are not in proportion with the distance between above said points and the head of the sinus node can hardly be explained by Sodi-Pallares's theory in which he says the stimulus conduction in the atria is of the nature of diffusion. The author deems it more reasonable to explain the fact by accepting the assumption that there exists a stimulus conduction pathway in the atria.3) The main pathways are assumed to be such as ; (i) one coming downward from the head of the sinus mode along the taenia terminalis toward the vena cava inferior ; (ii) one proceeding from the middle part of the sinus node descendens of the middle of the anterior wall of the right atrium toward the vena cave inferior ; (iii) one which branches off the above mentioned pathway on its way ascending the middle part of the right atrium toward the right appendage : (iv) one coming directly from the head of the sinus node toward the left atrium through the Bachmann's bundle ; (v) one which branches off the Bachmann's bundle descends the anterior wall of the right atrium along the region bordering the septum. Stimulus conduction all over the atria is assumed to be carried out through a number of pathway that have branched off the above said main pathway.4) The form of P wave in the unipolar lead E.C.G. of the atrial surface has no definite relation with activation time.5) Of all the atrial surface the region where stimulus arrival is the latest is a place in the posterior wall of the left atrium near where it borders the ventricle.
- 1958-12-20
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