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Simplified Esophageal Electrocardiography Using Bipolar Recording Leads

STEPHEN C. HAMMILL, M.D.; and EDWARD L. C. PRITCHETT, M.D.
[+] Article and Author Information

▸Requests for reprints should be addressed to Stephen C. Hammill, M.D.; Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55901.


Durham, North Carolina


© 1981 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1981;95(1):14-18. doi:10.7326/0003-4819-95-1-14
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Diagnosing cardiac arrhythmias is easier if the P wave can be identified clearly. Esophageal electrocardiography with a unipolar recording lead attached to the V1 terminal of an ECG machine has been used in the past to show P waves. We used both bipolar and unipolar recording leads and standard ECG equipment to record the esophageal ECG and then compared the results obtained with both leads. Twenty-two cardiac rhythms were evaluated in 15 patients. The unipolar lead recorded a P wave that was smaller than the QRS complex (0.83 ± 0.47 mV and 1.28 ± 0.79 mV, respectively, p < 0.01) and was obscured when the two depolarizations were nearly simultaneous. The bipolar lead recorded a P wave that was larger than the QRS complex (0.93 ± 0.62 mV and 0.33 ± 0.3 mV, respectively, p < 0.001) and was never obscured. The unipolar lead recorded a P-to-QRS ratio that was smaller than that recorded by the bipolar lead (0.8 ± 0.5 and 3.3 ± 1.8, respectively, p < 0.001). A bipolar esophageal lead can be recorded simply at the bedside using a standard ECG machine and is superior to the conventional unipolar lead.

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