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Prognosis in patients with intra-Hisian conduction disturbances
Insights
Intra-Hisian delay, a conduction defect, rarely occurs alone. Patients with higher degrees of delay often require pacemakers for symptomatic bradyarrhythmias or syncope.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Conduction System
Background:
- Intra-Hisian delay is typically linked to fascicular conduction abnormalities.
- This study focuses on patients where intra-Hisian delay is the sole identified conduction defect.
Purpose of the Study:
- To investigate the clinical presentation and management of patients with isolated intra-Hisian delay.
- To evaluate the necessity and efficacy of permanent pacing in this patient cohort.
Main Methods:
- Retrospective analysis of 23 patients with intra-Hisian delay as their only conduction defect.
- Classification of delay severity (first-degree vs. higher degrees) and assessment of symptoms like syncope and bradyarrhythmias.
- Evaluation of pacemaker implantation and follow-up outcomes.
Main Results:
- 17 patients had first-degree intra-Hisian delay; 3 received pacemakers due to syncope.
- 6 patients had higher degrees of delay, with 5 requiring pacemakers for symptomatic bradyarrhythmias or syncope.
- No recurrence of symptoms post-pacemaker insertion (mean follow-up 31 months).
- No pacemaker recipients with first-degree delay developed symptoms during 21 months follow-up.
Conclusions:
- Isolated intra-Hisian delay can be a significant finding, particularly with higher degrees of delay.
- Permanent pacing is effective in managing symptomatic bradyarrhythmias and syncope in these patients.
- First-degree intra-Hisian delay without symptoms may not necessitate pacemaker intervention.
Abstract:
Intra-Hisian delay is usually associated with fascicular conduction abnormalities. We report our experience in 23 patients who had intra-Hisian delay as their only conduction defect. First-degree intra-Hisian delay (His bundle deflection greater than or equal to 30 msec) was present in 17 patients, 5 of whom also had split His potentials. Three of these patients received permanent pacemakers, all of whom had a history of syncope. Higher degrees of intra-Hisian delay were observed either spontaneously or in response to atrial pacing in 6 patients. Five of these patients were treated with permanent pacing, 4 of whom had symptomatic bradyarrhythmias and/or syncope. No patient has had a recurrence of symptoms following pacemaker insertion during the mean 31-month follow-up. No patient with first-degree intra-Hisian delay not receiving a pacemaker developed symptomatic bradyarrhythmias or syncope during a mean follow-up of 21 months.