Presentation is loading. Please wait.

Presentation is loading. Please wait.

Prakash G. Suryanarayana, MD, David S. Frankel, MD, FHRS, Francis E

Published byAntony Singleton Modified over 5 years ago

Similar presentations

Presentation on theme: "Prakash G. Suryanarayana, MD, David S. Frankel, MD, FHRS, Francis E"— Presentation transcript:

1 Painful left bundle branch block syndrome treated successfully with permanent His bundle pacing 
Prakash G. Suryanarayana, MD, David S. Frankel, MD, FHRS, Francis E. Marchlinski, MD, FHRS, Robert D. Schaller, DO, FHRS  HeartRhythm Case Reports  Volume 4, Issue 10, Pages (October 2018) DOI: /j.hrcr Copyright © 2018 Heart Rhythm Society Terms and Conditions

2 Figure 1 Right atrial pacing at a rate of 85 beats per minute with a narrow QRS and no pain with eventual transition to left bundle branch block and immediate symptom onset. Upon cessation of pacing and aberrancy resolution, the pain subsided. HeartRhythm Case Reports 2018 4, DOI: ( /j.hrcr ) Copyright © 2018 Heart Rhythm Society Terms and Conditions

3 Figure 2 A: Nonselective His bundle pacing with an output of 1.0 ms resulting in a narrow QRS of 108 ms and no pain. When the pacing output is decreased to ms, loss of His bundle capture occurs, the QRS widens, and pain is reported. B: Normal sinus rhythm with native ventricular conduction and development of persistent right bundle branch block (asterisks) after deployment of the His bundle pacing lead. Note that the PR interval increases from 200 ms to 230 ms with the onset of aberrant ventricular conduction, suggesting delay in the left bundle branch. HeartRhythm Case Reports 2018 4, DOI: ( /j.hrcr ) Copyright © 2018 Heart Rhythm Society Terms and Conditions

4 Figure 3 A: Baseline native QRS, which is narrow. B: Pacing at ms results in selective His bundle pacing (HBP) with left bundle branch block (LBBB) correction, as evidenced by an initial isoelectric interval (black arrows) and a similar QRS morphology on 12-lead electrocardiogram. Note that there are subtle ventricular repolarization changes owing to a faster pacing rate. Pacing at ms also results in selective HBP without LBBB correction and chest pain ensues. Identical responses were seen during both dual-chamber and ventricular-only pacing configurations. The selective nature of both manifestations is confirmed by a discrete local ventricular electrogram, as seen on the pacing lead (red arrows). HeartRhythm Case Reports 2018 4, DOI: ( /j.hrcr ) Copyright © 2018 Heart Rhythm Society Terms and Conditions

5 Supplemental Figure 1 Anterior-posterior chest radiograph showing the position of the right atrium (RA) and His bundle pacing (HBP) leads. HeartRhythm Case Reports 2018 4, DOI: ( /j.hrcr ) Copyright © 2018 Heart Rhythm Society Terms and Conditions

Download ppt "Prakash G. Suryanarayana, MD, David S. Frankel, MD, FHRS, Francis E"

Similar presentations

HeartRhythm Case Reports

HeartRhythm Case Reports
Gopi Dandamudi, MD, FHRS, Pugazhendhi Vijayaraman, MD, FHRS 

Gopi Dandamudi, MD, FHRS, Pugazhendhi Vijayaraman, MD, FHRS 
Electrical resynchronization induced by direct His-bundle pacing

Electrical resynchronization induced by direct His-bundle pacing
Ablation of ventricular tachycardia from the aortic root after transcatheter aortic valve replacement  Uma N. Srivatsa, MBBS, MAS, FHRS, Eric J. Nordsieck,

Ablation of ventricular tachycardia from the aortic root after transcatheter aortic valve replacement  Uma N. Srivatsa, MBBS, MAS, FHRS, Eric J. Nordsieck,
His-bundle pacing in a patient with dextrocardia, severe systolic dysfunction, and complete atrioventricular block  Manuel Molina-Lerma, MD, Juan Jiménez-Jáimez,

His-bundle pacing in a patient with dextrocardia, severe systolic dysfunction, and complete atrioventricular block  Manuel Molina-Lerma, MD, Juan Jiménez-Jáimez,
Inappropriate shock from delayed T-wave oversensing by a subcutaneous implantable cardioverter-defibrillator after septal myectomy for hypertrophic cardiomyopathy 

Inappropriate shock from delayed T-wave oversensing by a subcutaneous implantable cardioverter-defibrillator after septal myectomy for hypertrophic cardiomyopathy 
A case of paroxysmal atrioventricular block–induced cardiac arrest

A case of paroxysmal atrioventricular block–induced cardiac arrest
Paradoxical reflex bradycardia after epinephrine infusion for arrhythmia induction in the electrophysiology laboratory  Timothy R. Larsen, DO, Karoly.

Paradoxical reflex bradycardia after epinephrine infusion for arrhythmia induction in the electrophysiology laboratory  Timothy R. Larsen, DO, Karoly.
Challenges in the diagnosis and management of idiopathic ventricular fibrillation  Jonathan Lipton, MD, PhD, George J. Klein, MD, Raymond W. Sy, MBBS,

Challenges in the diagnosis and management of idiopathic ventricular fibrillation  Jonathan Lipton, MD, PhD, George J. Klein, MD, Raymond W. Sy, MBBS,
Is it bradycardia or something else causing symptoms?

Is it bradycardia or something else causing symptoms?
Ruchit Shah, MD, Vineet Kumar, MD, FHRS  HeartRhythm Case Reports 

Ruchit Shah, MD, Vineet Kumar, MD, FHRS  HeartRhythm Case Reports 
Permanent His bundle pacing at the time of atrioventricular node ablation: A 3- dimensional mapping approach  Sukit Ringwala, MD, MPH, Bradley P. Knight,

Permanent His bundle pacing at the time of atrioventricular node ablation: A 3- dimensional mapping approach  Sukit Ringwala, MD, MPH, Bradley P. Knight,
Irregular wide QRS complex tachycardia in a patient with pulmonary hypertension: What is the mechanism?  Abigail Louise D. Te, MD, Fa-Po Chung, MD, Yenn-Jiang.

Irregular wide QRS complex tachycardia in a patient with pulmonary hypertension: What is the mechanism?  Abigail Louise D. Te, MD, Fa-Po Chung, MD, Yenn-Jiang.
Resolution of the functional retrograde right bundle branch block during antidromic atrioventricular reciprocating tachycardia  Keiko Takahashi, MD, PhD,

Resolution of the functional retrograde right bundle branch block during antidromic atrioventricular reciprocating tachycardia  Keiko Takahashi, MD, PhD,
Limitations of 12-lead electrocardiogram wide complex tachycardia algorithms in a patient with left atrial flutter and large myocardial infarction  Carlos.

Limitations of 12-lead electrocardiogram wide complex tachycardia algorithms in a patient with left atrial flutter and large myocardial infarction  Carlos.
Increased threshold in nonselective His-bundle pacing suspected to be caused by amiodarone  JoonHyuk Kim, MD, Seth Goldbarg, MD, FHRS, Steven Leung, MD,

Increased threshold in nonselective His-bundle pacing suspected to be caused by amiodarone  JoonHyuk Kim, MD, Seth Goldbarg, MD, FHRS, Steven Leung, MD,
Atrial pacing for the management of ventricular arrhythmias in Andersen-Tawil syndrome  Opeyemi Fadahunsi, MBBS, MPH, Bilal Shaikh, DO, Andrew Rettew,

Atrial pacing for the management of ventricular arrhythmias in Andersen-Tawil syndrome  Opeyemi Fadahunsi, MBBS, MPH, Bilal Shaikh, DO, Andrew Rettew,
Atrioventricular block and pause-dependent torsade de pointes

Atrioventricular block and pause-dependent torsade de pointes
Atrial fibrillation originating from recipient left atrium after an orthotopic heart transplantation  Auroa Badin, MD, Jaret Tyler, MD, FHRS, Steven J.

Atrial fibrillation originating from recipient left atrium after an orthotopic heart transplantation  Auroa Badin, MD, Jaret Tyler, MD, FHRS, Steven J.
Left axillary active can positioning markedly reduces defibrillation threshold of a transvenous defibrillator failing to defibrillate at maximum output 

Left axillary active can positioning markedly reduces defibrillation threshold of a transvenous defibrillator failing to defibrillate at maximum output 

Similar presentations

Ads by Google