1. 1. The pattern of ventricular potential variation distributed to the left leg, which Wolferth, Livezey, and Wood called the diaphragmatic pattern, is likewise distributed to the anterior and posterior surfaces of the abdomen below the umbilicus, and to the jejunum and the duodenum. It is distributed to the stomach, although, in certain cases, particularly when the exploring electrode is moved to a position directly under and near the heart, the pattern is not faithfully maintained. 2. 2. The amplitude of potential variations does not tend to change materially between a position as near the heart as the pyloric region of the stomach and as far away as the left leg. Decrement between the heart and the posterior surface of the back, however, tends to be greater than that between the heart and the left leg. There is appreciable decrement between the fundus and the pyloric end of the stomach. 3. 3. The pattern of ventricular potential variations recorded with the exploring electrode in the esophagus at the auricular level is similar in its general characteristics to the pattern obtained when an exploring electrode is placed within a ventricular cavity. When an exploring electrode is placed at the lower end of the esophagus, the pattern recorded may resemble either the pattern with widespread distribution below the diaphragm or the “endocardial pattern” recorded at the auricular level, or it may be intermediate in form between these two. 4. 4. When an electrode is placed either in the stomach or esophagus in positions close to the heart, bizarre electrocardiograms are occasionally obtained. These bizarre effects are attributed to movement of the electrode by the heart. 5. 5. The lower end of the esophagus, as judged from a series of controls, is an unfavorable position for the application of the exploring electrode in clinical electrocardiography because of the diversity of patterns found in normals and the apparently hopeless task of standardization of curves for that area. The “endocardial pattern” of potential variation recorded at the auricular level of the esophagus deserves further investigation. 6. 6. We have found no position, or combination of positions, for the application of an exploring electrode below the diaphragm, either on the body surface or within the lumen of the digestive tract, which is superior to the left leg for the study of ventricular electrical activity, although any position below the level of the umbilicus can be used to demonstrate the same pattern.
Read full abstract