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Discrimination between His-bundle and the right bundle branch during electrophysiologic studies

Yoshiaki Kaneko1, Tadashi Nakajima, Akihiro Saito

  • 1Department of Medicine and Biological Science, Graduate School of Medicine, Gunma University, Maebashi, Gunma, Japan. kanekoy@showa.gunma-u.ac.jp

Pacing and Clinical Electrophysiology : PACE
|March 3, 2009
PubMed

Insights

Identifying the His-bundle (HB) and right bundle branch (RBB) using the V3 phenomenon is feasible. However, measuring the His-ventricular (H-V) interval can lead to misidentifying the RBB as the HB.

Area of Science:

  • Electrophysiology
  • Cardiac conduction system

Background:

  • Accurate identification of the His-bundle (HB) and right bundle branch (RBB) is crucial in electrophysiologic studies.
  • Distinguishing between HB and RBB can be challenging, impacting diagnostic accuracy.

Purpose of the Study:

  • To identify the His-bundle (HB) versus right bundle branch (RBB) during electrophysiologic studies.
  • To utilize the V3 phenomenon for HB and RBB identification.
  • To compare the His-ventricular (H-V) interval timing for HB and RBB potentials.

Main Methods:

  • Electrophysiologic studies were performed on 16 patients without structural heart disease.
  • The V3 phenomenon was induced to record HB and RBB potentials using a multi-electrode catheter.
  • Specific recording sites were defined: HB branching portion (HBBP), proximal HB, and distal RBB.

Main Results:

  • The HBBP was successfully identified in all patients.
  • The H-V interval at the HB adjacent to the HBBP was ≥35 ms in most patients.
  • The H-V interval at the RBB adjacent to the HBBP was also ≥35 ms in 12 patients.

Conclusions:

  • Simultaneous recording of HB and RBB potentials during V3 phenomenon induction allows for feasible electrophysiologic identification.
  • Relying solely on H-V interval measurements for discrimination frequently leads to misidentification of the proximal RBB as the HB.
Abstract

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