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An interesting case of infra-hisian block
Harini Lakshman1, Sukriti Banthiya2, Ammar Ahmed1
1Department of Cardiovascular Medicine, Ascension Providence Hospital, Southfield, Michigan, USA.
Insights
This case report details a patient with atrial flutter and conduction disease who experienced syncope. Electrophysiology studies revealed intra-Hisian block, leading to pacemaker implantation and symptom resolution.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Conduction System
Background:
- Supraventricular arrhythmias and conduction disease pose significant clinical challenges.
- Intra-Hisian block, characterized by delayed conduction in the His bundle, can cause syncope.
Observation:
- A 65-year-old male with atrial flutter and pre-existing conduction blocks presented with recurrent syncope.
- Electrophysiology studies post-ablation revealed intra-Hisian block and prolonged HV intervals.
- Intra-Hisian delay was observed during pacing, progressing to block during atrioventricular block events.
Findings:
- The patient's syncopal episodes were directly linked to atrial flutter and subsequent intra-Hisian block.
- Electrophysiology studies are crucial for diagnosing intra-Hisian block in patients with complex arrhythmias.
Implications:
- Pacemaker implantation effectively resolved syncopal episodes in this patient.
- Clinical awareness and electrophysiology studies are vital for managing intra-Hisian block and supraventricular arrhythmias.
Introduction:
The management of patients with conduction disease and supraventricular arrhythmias presents a multitude of clinical challenges.Intra-Hisian block, a condition characterized by delayed or blocked electrical conduction within the His bundle, can result in debilitating symptoms, such as syncope or presyncope. This case report aims to elucidate the diagnostic and therapeutic considerations that were taken in a patient who presented with recurrent syncopal episodes that corresponded to atrial flutter (AFL) and subsequently underwent cavotricuspid isthmus ablation.
Case Presentation:
A 65-year-old male with paroxysmal AFL and a pre-existing right bundle branch block and left anterior fascicular block (RBBB+LAFB) experienced recurrent syncopal episodes that were found to be correlated with AFL episodes. Following CTI ablation, an electrophysiology study (EPS) revealed a prolonged HV interval of 101ms, which indicated potential conduction abnormalities. With coronary sinus pacing, an intra-Hisian delay of 211ms was observed. During instances of atrioventricular block, intra-Hisian delay was evident on conducted beats, followed by intra-Hisian block on non-conducted beats. Ultimately, the patient's syncopal episodes prompted the placement of a dual-chamber pacemaker, which resulted in the resolution of symptoms.
Conclusion:
Intra-Hisian block is a condition that is often associated with delayed or blocked electrical conduction within the His bundle. When symptomatic, patients often present with syncope or presyncope. Etiologies of this condition include degenerative changes, myocardial infarction, autoimmune disorders, infections, medications, and more. This case emphasizes the importance of electrophysiology studies (EPS) in the diagnosis and management of patients with intra-Hisian block. Prompt intervention, such as the placement of a dual-chamber pacemaker, can alleviate symptoms and improve patient outcomes. Thus, clinical awareness and utilization of EPS can aid in accurate diagnosis and appropriate treatment selection for patients with conduction abnormalities and supraventricular arrhythmias.cuspid isthmus (CTI) ablation.
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