Abstract
The QRS configuration is a representation of the pattern of ventricular activation. Normally both ventricles are activated relatively synchronously and symmetrically giving rise to a narrow QRS complex. Ventricular activation is initiated along the left side of the interventricular septum and shortly thereafter (approximately 10 ms) at the anterior papillary muscle of the right ventricle [1]. An intact proximal His-Purkinje system, that is, the bundle branches, is required for the early and nearly simultaneous activation of both ventricles. While the ventricular muscle is activated at these regions, the impulse continues through the more distal His-Purkinje system to initiate activation at other ventricular sites. As the impulse continues through the distal His-Purkinje system, ventricular muscle is activated from endocardium to epicardium at each point of endocardial excitation [1]. Thus, it is apparent that a normal QRS morphology is dependent upon the functional and/or anatomic integrity of both the proximal and distal His-Purkinje system as well as factors influencing intramyocardial conduction.
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© 1981 Martinus Nijhoff Publishers, The Hague
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Josephson, M.E., Waxman, H.L., Marchlinski, F.E., Horowitz, L.N., Spielman, S.R. (1981). Relation between Site of Origin and QRS Configuration in Ventricular Rhythms. In: Wellens, H.J.J., Kulbertus, H.E. (eds) What’s New in Electrocardiography. Springer, Dordrecht. https://doi.org/10.1007/978-94-009-8239-0_12
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DOI: https://doi.org/10.1007/978-94-009-8239-0_12
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