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Journal of Interventional Cardiac Electrophysiology

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01-09-2009 | CASE REPORT

QRS complex widening due to loss of left bundle branch capture: pitfall of para-Hisian pacing

Authors: Masamitsu Adachi, Osamu Igawa, Junichiro Miake, Akio Yano, Yoshiaki Inoue, Kazuyoshi Ogura, Masaru Kato, Kazuhiko Iitsuka, Ichiro Hisatome

Published in: Journal of Interventional Cardiac Electrophysiology | Issue 3/2009

Abstract

During para-Hisian pacing, widening of the paced QRS complex usually indicates loss of His bundle capture. We describe a patient without any accessory pathways in whom widening of the paced QRS complex occurred due to loss of left bundle branch capture during para-Hisian pacing. After initial widening of the QRS complex, further widening was observed due to loss of His bundle capture. With the initial QRS widening, the stimulus-atrial interval and retrograde atrial activation sequence were almost unchanged, so the findings mimicked retrograde conduction over an accessory pathway. This may be a pitfall of the para-Hisian pacing technique.

Jackman, W. M., Wang, X., Friday, K. J., Roman, C. A., Moulton, K. P., & Beckman, K. J. (1991). Catheter ablation of accessory atrioventricular pathways Wolff-Parkinson-White syndrome by radiofrequency current. The New England Journal of Medicine, 324, 1605–1611.PubMed

Hirao, K., Otomo, K., Wang, X., Beckman, K. J., McClelland, J. H., & Widman, L. (1996). Para-Hisian pacing: a new method for differentiating retrograde conduction over an accessory AV pathway from conduction over the AV node. Circulation, 94, 1027–1035.PubMed

Nakagawa, H., & Jackman, W. M. (2005). Para-Hisian pacing: Useful clinical technique to differentiate retrograde conduction between accessory atrioventricular pathways and atrioventricular nodal pathways. Heart Rhythm, 6, 667–672.CrossRef

Title: QRS complex widening due to loss of left bundle branch capture: pitfall of para-Hisian pacing
Authors: Masamitsu Adachi
Osamu Igawa
Junichiro Miake
Akio Yano
Yoshiaki Inoue
Kazuyoshi Ogura
Masaru Kato
Kazuhiko Iitsuka
Ichiro Hisatome
Publication date: 01-09-2009
Publisher: Springer US
Published in: Journal of Interventional Cardiac Electrophysiology / Issue 3/2009
Print ISSN: 1383-875X
Electronic ISSN: 1572-8595
DOI: https://doi.org/10.1007/s10840-008-9345-8

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QRS complex widening due to loss of left bundle branch capture: pitfall of para-Hisian pacing

Abstract

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Abstract

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