A new catheter technique for His bundle recordings via the arm veins.

A new techniquefor recording His bundle and right bundle-branch electrograms via the arm veins is described.In 25 patients an ordinary bipolar pacing catheter was introduced into an arm vein and the tip positioned in the right atrium.The catheter tip was looped in a figure-of-six (6) shape in the right atrium.The loop was advanced across the tricuspid valve into the right ventricle.A slight withdrawal of the catheter results in partial opening of the loop and approximation of the catheter tip to the vicinity of the His bundle.Further withdrawal ofthe catheter tip results in additional opening ofthe loop into a Ushape with the tip directed towards the outflow tract of the right ventricle, enabling one to record right bundle-branch potentials.In If of the 25 patients simultaneous His bundle recordings were obtained by the above approach and via the conventional femoral route; the His bundle electrograms were similar in shape and duration.The conduction times, i.e.AH and HV, were also similar during normal sinus rhythm and atrial stimulation.The procedure time via the arm veins was comparable to or even shorter than the time required by the femoral approach.The new catheter technique, i) provides an alternative route for catheter introduction in patients in whom femoral veins cannot be used, and 2) may prove to be the method of choice in selected cases requiring long-term monitoring ofHis bundle potentials in view of the stability of the His bundle recordings.