Catheter Induced Distal Intra-Hisian Right Bundle Branch Block in a Patient with Persistent Proximal Intra-Hisian Complete A-V Block |
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Authors: | PIETRO SANTARELLI FULVIO BELLOCCI FRANCESCO LOPERFIDO GERARDO ANSALONE ELDA COPPOLA PAOLO ZECCHI |
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Affiliation: | Department of Cardiology, Catholic University Medical School, Policlinico A. Gemelli, Rome, Italy |
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Abstract: | We describe a patient with complete intra-Hisian A-V block and narrow QRS who developed catheter-induced right bundle branch block during an electrophysiological study. Selective His bundle pacing was performed during complete intra-Hisian A-V block and right bundle branch block pattern; the distal His bundle pacing normalized the QRS complex, while a more proximal His bundle stimulation showed a right bundle branch block configuration with the persistence of the proximal intra-Hisian lesion responsible for the complete A-V block. These electrophysiological findings suggest that the catheter-induced right bundle branch block in our patient was due to a focal lesion in the distal part of the main His bundle. To our knowledge, this is the first report of documented multilevel lesions within the His bundle in man. |
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Keywords: | His pacing intra-Hisian lesion |
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