Circulation, Vol 53, 776-783, Copyright © 1976 by American Heart Association
HC Cohen, I D'Cruz and A Pick
Multiple areas of concealed intraventricular conduction are deduced on the
basis of aftereffects observed in His bundle recordings. Electrocardiograms
and His bundle recordings are presented from two patients with unstable
bilateral bundle branch block, the instability of which depended on the
interval at which ventricular depolarization was initiated by sinus or
paced impulses. This circumstance allows postulation of 1) concealed
transseptal retrograde penetration of the left bundle branch system; 2)
concealed transseptal retrograde penetration of the right bundle branch
system; 3) alternate beat Wenckebach phenomenon with two areas of block in
the bundle branch system with concealed penetration of the proximal area;
4) concealed re- entry in the right bundle branch system during an H-V
Wenckebach cycle with resetting of the sequence of 2:1 H-V block and return
of the re- entry wave to the A-V node causing subsequent A-H block; 5)
proximal 2:1 block and distal Wenckebach block producing only two
consecutively blocked beats; and 6) infrahisian Wenckebach block with
changes both in A-V conduction and QRS contour.
ARTICLES
Concealed intraventricular conduction in the His bundle electrogram
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