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HeartRhythm Case Reports

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Presentation on theme: "HeartRhythm Case Reports"— Presentation transcript:

1 HeartRhythm Case Reports
Permanent left posterior fascicular area pacing through the interventricular septum in a patient with infra-Hisian block  Li-Jun Zeng, MD, Yun-Qiu Jiang, MD, Yan-Jiang Wang, MD, Liang Shi, MD, Ying Tian, MD, Xing-Peng Liu, MD  HeartRhythm Case Reports  DOI: /j.hrcr Copyright © 2019 Heart Rhythm Society Terms and Conditions

2 Figure 1 Twelve-lead electrocardiography (ECG) and intracardiac electrograms of the patient. A: Baseline ECG showed sinus rhythm, 2:1 atrioventricular block, and right bundle branch block. The arrow indicates the P wave. B–D: From top to bottom, the image shows leads I, II, III, aVR, aVL, aVF, and V1 and the intracardiac electrograms recorded by the 3830 lead. B: The prolonged HV interval was 242 ms in conducted sinus beats, and the following nonconducted sinus beats showed atrio-His (AH) block. C: The impulses were not conducted to the ventricle during pacing from the His bundle region. D: A sharp Purkinje (P) potential with normal P to ventricular interval was recorded deep in the interventricular septum. The sweep speed of the tracing in A and in B–D was 25 mm/s and 100 mm/s, respectively. A = atrial electrogram; V = ventricular electrogram. HeartRhythm Case Reports DOI: ( /j.hrcr ) Copyright © 2019 Heart Rhythm Society Terms and Conditions

3 Figure 2 Lead position determined by fluoroscopy and echocardiography. A: The angiography performed using the C315 sheath in the anteroposterior view. B: Fluoroscopic image in the right anterior oblique view. C: Four-chamber view in echocardiography. The yellow double arrow shows interventricular septum. The white arrow shows the 3830 ventricular lead. IVS = interventricular septum; RAA = right atrial appendage. HeartRhythm Case Reports DOI: ( /j.hrcr ) Copyright © 2019 Heart Rhythm Society Terms and Conditions

4 Figure 3 Twelve-lead electrocardiography during unipolar and bipolar pacing, respectively. A: Unipolar pacing resulted in delayed right ventricular activation. The arrow shows a QR pattern in V1. B: Bipolar pacing showed attenuated R wave in V1. The left axis deviation in both electrocardiograms indicated left anterior fascicular block. HeartRhythm Case Reports DOI: ( /j.hrcr ) Copyright © 2019 Heart Rhythm Society Terms and Conditions

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