Right atrial electrocardiogram in the analysis of arrhythmias following acute myocardial infarction.

The routine use of continuous cardiac monitoring in intensive coronary care units has demonstrated a high incidence of cardiac arrhythmias following acute infarction (Julian, Valentine, and Miller, 1964; Meltzer and Kitchell, 1966; Fluck et al., 1967; Lown et al., 1967). A prerequisite in assessing the value of therapeutic measures used to terminate any arrhythmia is that the arrhythmia and its prodromata should be precisely analysed. Using conventional electrocardiographic monitoring, this is not always possible since atrial activity may be poorly defined. In this situation right atrial electrocardiograms are of value and the technique has important advantages over oesophageal leads. Direct intracavitary recordings were first reported by Hellerstein, Pritchard, and Lewis (1949), and recently Vogel et al. (1964) and Dreifus et al. (1965) have stressed the potential value of this technique at the bedside in the differentiation of complex arrhythmias. This paper describes our experience of the value of the right atrial electrocardiogram in an intensive coronary care unit.