Key result
HBP and LBBP show His bundle splitting and intrahisian Wenckebach, indicating longitudinal conduction system dissociation.
Why the study?
Evidence of longitudinal dissociation of the conduction system was rare.
Case Report (n=1)
No
This case report provides unique intracardiac electrogram recordings during His and left bundle branch pacing that support the concept of longitudinal dissociation within the conduction system.
Supports longitudinal dissociation via novel recordings; hypothesis-generating case report that should not yet change practice.
Abstract Background Evidence of the conduction system longitudinal dissociation was rare. Case presentation We report a case of a third-degree atrioventricular block. During HB pacing (HBP) lead deployment, widening and splitting of HB potential and intrahisian Wenckebach phenomenon were recorded in intracardiac electrogram. Then, we began unipolar HBP at 2 V/0.5 ms.The paced QRS exhibited morphology identical to that during intrinsic rhythm, indicating selective capture of the HB. After stopping screw; three different QRS patterns were recorded at unipolar 1.3mv/0.5ms pacing. During His injury repairment, the H1-H2 interval was gradually shortened, the H1 potential was seems invisible and integrated into H potential. When LBB electrode was screwed in at 2V/0.5ms continuous pacing condition, the His lead showed obvious double potential reverse transmission (H2-H1) at the presence of S-LBBP. Conclusion The interesting finding in this case provided further electrophysiological evidences for longitudinal dissociation of the conduction system.
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Li et al. (2023) conducted a case report in Atrial flutter and third-degree atrioventricular block (n=1). His bundle pacing and left bundle branch pacing (HBP+LBBP) was evaluated on Electrophysiological evidence of longitudinal dissociation of the conduction system. His bundle and left bundle branch pacing demonstrated splitting of the His bundle potential and intrahisian Wenckebach phenomenon, providing evidence for longitudinal conduction system dissociation.
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