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Updated: Jul 12, 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
Functional bundle branch block and orthodromic reciprocating tachycardia cycle length: do not bet on accessory
Fabrice Extramiana1, Seiji Takatsuki, Meiso Hayashi
1Department of Cardiology, Lariboisière Hospital, APHP, Paris 7 University, Paris, France. fabrice.extramiana@lrb.aphp.fr
Aims:
To show 2 examples in which the analysis of the effect of bundle branch block on orthodromic reciprocating tachycardia cycle length was misleading.
Methods And Results:
We performed an electrophysiological study in two patients with orthodromic reciprocating tachycardia showing a transition from wide to narrow QRS during tachycardia. Our two cases of left bundle branch block during reciprocating tachycardia using infero-septal pathways show that ventricular to atrial conduction time prolongation may be larger than 30 ms and may be concealed by a shortening of atrial to ventricular conduction time. In the 2 cases, the atrial insertion of the accessory pathway could be successfully ablated from the right atria at the ostium of the coronary sinus.
Conclusions:
The observation of the association between left bundle branch block and cycle length prolongation during reciprocating tachycardia may be associated with a successful ablation at the ostium of the coronary sinus.
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