Key result
Selective distal His bundle pacing normalized the QRS complex in a patient with complete intra-Hisian A-V block and catheter-induced right bundle branch block.
Case Report (n=1)
This case provides the first documented evidence of multilevel lesions within the His bundle in a human, demonstrated through selective His bundle pacing.
May warrant targeted pacing trials in refractory intra-Hisian block; leaves open prevalence and generalizability of multilevel His lesions.
We describe a patient with complete intra-Hisian A-V block and narrow QRS who developed catheter-induced right bundle branch block during an electrophysiological study. Selective His bundle pacing was performed during complete intra-Hisian A-V block and right bundle branch block pattern; the distal His bundle pacing normalized the QRS complex, while a more proximal His bundle stimulation showed a right bundle branch block configuration with the persistence of the proximal intra-Hisian lesion responsible for the complete A-V block. These electrophysiological findings suggest that the catheter-induced right bundle branch block in our patient was due to a focal lesion in the distal part of the main His bundle. To our knowledge, this is the first report of documented multilevel lesions within the His bundle in man.
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Santarelli et al. (1981) conducted a case report in Complete intra-Hisian A-V block and narrow QRS (n=1). Selective His bundle pacing was evaluated on QRS complex normalization. Selective distal His bundle pacing normalized the QRS complex in a patient with complete intra-Hisian A-V block and catheter-induced right bundle branch block.
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