His bundle recordings demonstrate that the zone of concealment in atrial fibrillation and flutter is located proximal to the His bundle, allowing for the differentiation of aberrant from premature ventricular beats.
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His bundle recordings may differentiate aberrant from ventricular beats in AF; leaves open validation before any clinical adoption.
Seven patients with atrial fibrillation and six patients with atrial flutter were studied using the technic of His bundle recordings. All 13 patients received digitalis. In atrial fibrillation each QRS complex (except for premature ventricular beats) was preceded by a single His bundle deflection. Complete block distal to the His bundle was not observed. Thus, the zone of concealment could be localized to the region proximal to the His bundle. The clinical findings were confirmed in three animal experiments. In atrial flutter the nonconducted P waves were also blocked proximal to the His bundle. In atrial fibrillation aberrant ventricular beats were distinguished from premature ventricular beats by the presence of a preceding His deflection in the former and its absence in the latter.
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Lau et al. (1969) studied this question.
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