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Additional evidence for re-entry within the bundle branches in man

J R Foster, R J Simpson

    Pacing and Clinical Electrophysiology : PACE
    |October 1, 1978
    PubMed
    Summary
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    Ventricular extrastimulus testing can reveal repetitive ventricular beats (V3) due to critical conduction delays. This study provides evidence supporting bundle branch re-entry as the mechanism for V3, excluding local re-entry.

    Area of Science:

    • Electrophysiology
    • Cardiac Arrhythmias
    • Cardiology

    Background:

    • Ventricular extrastimulus testing is crucial for understanding ventricular arrhythmias.
    • Repetitive, non-paced ventricular beats (V3) occur at short coupling intervals.
    • The mechanism of V3, particularly the role of re-entry, remains debated.

    Observation:

    • A specific case of V3 during ventricular extrastimulus testing was analyzed.
    • Both His potential and right bundle branch potential were consistently recorded before V3.
    • The anterograde activation sequence of these potentials was meticulously documented.

    Findings:

    • The recorded activation sequence refutes local re-entry within the His-Purkinje system.
    • Evidence strongly supports re-entry involving the bundle branches as the underlying mechanism for V3.

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  • This finding clarifies the electrophysiological basis of V3 during extrastimulus testing.

    • Implications:

    • Understanding V3 mechanisms aids in diagnosing and managing ventricular arrhythmias.
    • This study refines the understanding of re-entry pathways in the His-Purkinje system.
    • Accurate V3 mechanism identification can improve therapeutic strategies for cardiac arrhythmias.