Demonstration of Re-entry within the His-Purkinje System in Man

The results of this study provide evidence that reentry within the His-Purkinje system can be consistently demonstrated in most human hearts when a critical degree of conduction delay is present within the HPS

MASOOD AKHTAR; ANTHONY N. DAMATO; WILLIAM P. BATSFORD; JEREMY N. RUSKIN; J. BIMBOLA OGUNKELU; GUILLERMO VARGAS

2012

Scholarcy highlights

  • In all patients who demonstrated 1:1 retrograde conduction during the basic ventricular drive a progressive increase in ventriculo-atrial conduction time occurred as the premature ventricular beat was introduced at progressively shorter S, S2 intervals
  • When S2 resulted in more than one ventricular beat, the H-V interval of subsequent beats was measured from the peak or nadir of the preceding His bundle electrogram to the earliest detectable ventricular activity as noted on the ECG or the His bundle electrogram recording. Both antegrade and retrograde refractory period studies were performed in all patients except one, only the results obtained during retrograde refractory period studies will be presented
  • The essential clinical and electrophysiologic data for all patients are summarized in table 1
  • The results of this study provide evidence that reentry within the His-Purkinje system can be consistently demonstrated in most human hearts when a critical degree of conduction delay is present within the HPS
  • If the most likely mechanism for this form of re-entry is that which is presented in panel B of figure 6, it is tempting to postulate that most patients with a complete RBBB pattern will not demonstrate the phenomenon following premature stimulation of the right ventricle since the right bundle branch would be refractory to antegrade conduction of the re-entrant impulse
  • Results obtained in this study suggest that multiple successive ventricular beats seen on standard ECG with wide bizarre QRS complexes may not necessarily originate from the ventricles but may represent A-V nodal re-entry or dissociated sinus captures

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