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(Circulation. 1969;40:71.)
© 1969 American Heart Association, Inc.

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A Study of Atrioventricular Conduction in Atrial Fibrillation and Flutter in Man Using His Bundle Recordings

SUN H. LAU M.D.¹; ANTHONY N. DAMATO M.D.¹; WALTER D. BERKOWITZ M.D.¹; ROBERT D. PATTON M.D.¹

¹ From the Cardiopulmonary Laboratory, U. S. Public Health Service Hospital, Staten Island, New York.

Seven patients with atrial fibrillation and six patients with atrial flutter were studied using the technic of His bundle recordings. All 13 patients received digitalis. In atrial fibrillation each QRS complex (except for premature ventricular beats) was preceded by a single His bundle deflection. Complete block distal to the His bundle was not observed. Thus, the zone of concealment could be localized to the region proximal to the His bundle. The clinical findings were confirmed in three animal experiments. In atrial flutter the nonconducted P waves were also blocked proximal to the His bundle. In atrial fibrillation aberrant ventricular beats were distinguished from premature ventricular beats by the presence of a preceding His deflection in the former and its absence in the latter.

Key Words: A-V nodal potentials • Premature ventricular beats • Right bundle-branch potentials • Concealed conduction • Zone of concealment • Carotid sinus stimulation • Aberrant ventricular conduction • Decremental conduction

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