His Bundle Extrasystoles Revisited: The Great Electrocardiographic Masquerader |
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| Authors: | ABDUL AMEEN MD AMITA DHARAWAT MD ABDULLAH KHAN MD GIOIA TURITTO MD NABIL EL‐SHERIF MD |
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| Affiliation: | New York Harbor VA Healthcare Center, State University of New York Downstate Medical Center, Brooklyn, New York |
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| Abstract: | A 74‐year‐old man with past history of near syncope presented with frequent periods of second‐degree atrioventricular block (2° AVB). An electrophysiological study revealed prolonged atrial‐His and His‐ventricular (HV) intervals and frequent His bundle (H) extrasystoles. The latter manifested in the surface electrocardiogram as premature atrial, junctional, or ventricular beats, as well as 2° AVB that mimicked Wenckebach or Mobitz II block. Procainamide markedly suppressed H extrasystole. However, because of the presence of prolonged HV interval and history of presyncope, a permanent pacemaker was inserted. The case illustrates the varied manifestation of H extrasystole and presents guidelines for management. (PACE 2011; e56–e59) |
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| Keywords: | electrocardiogram electrophysiology— clinical pharmacology |
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