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Catheter induced distal intra-Hisian right bundle branch block in a patient with persistent proximal intra-Hisian
Insights
This study details a patient with complete atrioventricular (AV) block and narrow QRS who developed catheter-induced right bundle branch block. Pacing revealed distinct His bundle lesions, suggesting multilevel His bundle pathology.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Anatomy
Background:
- Complete intra-Hisian atrioventricular (AV) block presents diagnostic challenges.
- Electrophysiological studies are crucial for understanding complex conduction abnormalities.
Observation:
- A patient with complete intra-Hisian AV block and narrow QRS developed catheter-induced right bundle branch block (RBBB) during an electrophysiological study.
- Selective His bundle pacing demonstrated differential effects based on stimulation site.
Findings:
- Distal His bundle pacing normalized the QRS complex in the setting of complete AV block and RBBB.
- Proximal His bundle stimulation revealed persistent RBBB, indicating a proximal His bundle lesion.
- These findings suggest a focal lesion in the distal His bundle caused the catheter-induced RBBB.
Implications:
- This case is the first to document multilevel lesions within the His bundle in humans.
- Understanding His bundle anatomy and potential lesion sites is critical for interpreting electrophysiological findings.
- Highlights the importance of precise catheter manipulation during His bundle pacing.
Abstract:
We describe a patient with complete intra-Hisian A-V block and narrow QRS who developed catheter-induced right bundle branch block during an electrophysiological study. Selective His bundle pacing was performed during complete intra-Hisian A-V block and right bundle branch block pattern; the distal His bundle pacing normalized the QRS complex, while a more proximal His bundle stimulation showed a right bundle branch block configuration with the persistence of the proximal intra-Hisian lesion responsible for the complete A-V block. These electrophysiological findings suggest that the catheter-induced right bundle branch block in our patient was due to a focal lesion in the distal part of the main His bundle. To our knowledge, this is the first report of documented multilevel lesions within the His bundle in man.