Double ventricular response caused by longitudinal dissociation in the his bundle
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Updated: Oct 3, 2026

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
Published on: December 11, 2017
Takakazu Katoh1, Shinji Kinoshita, Yoshinori Tsujimura
1Katoh Cardiovascular Clinic, Ohtsu, Japan.
Abstract:
Electrocardiograms were taken from a 36-year-old woman with normal sinus rhythm in which 4 types of QRS complexes and 2 types of fusion QRS complexes were found in configuration. To interpret this arrhythmia, we proposed 3 unique mechanisms: a) double ventricular response through the fast pathway mainly directing to the right bundle branch and the slow pathway mainly directing to the left bundle branch, b) longitudinal dissociation in the His bundle, and c) transverse conduction in the lower edge of the dissociation. Although functional longitudinal dissociation in the atrioventricular node has been reported, longitudinal dissociation in the His bundle is a rare arrhythmia.
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