Circulation, Vol 60, 1455-1464, Copyright © 1979 by American Heart Association
RC Dhingra, C Wyndham, R Bauernfeind, S Swiryn, PC Deedwania, T Smith, P Denes and KM Rosen
Twenty-one of 496 (4%) patients with chronic bifascicular block, studied
and followed prospectively, had block distal to the His bundle (BDH)
induced by atrial pacing during initial electrophysiologic studies. In six,
BDH was noted during pacing-induced atrioventricular (AV) nodal Wenckebach
periods (at paced rates of 150--190 beats/min), with BDH in the short HH
cycles after the AV nodal blocked P (lond cycle). The AH interval was
normal in all six patients and HV was normal in four. None of the six
patients has developed AV block during a mean follow-up of 5.33 +/- 0.48
years. In 15 patients, pacing-induced BDH was noted during intact AV nodal
conduction (paced rate of 80--200 beats/min). The AH interval was prolonged
in one, and HV was prolonged in 10 of the 15 patients. During a mean
follow-up of 3.4 +/- 0.59 years, seven of these patients developed AV
block, one had treadmill- provoked AV block, and two died suddenly (major
morbid event in 10 of 15 patients). In conclusion, BDH induced by atrial
pacing is an infrequent finding in patients with bifascicular block, and
can be a functional as well as a pathologic response. The latter is
associated with a high risk of major morbid events (AV block and sudden
death).
ARTICLES
Significance of block distal to the His bundle induced by atrial pacing in patients with chronic bifascicular block
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