Congenital and surgical atrioventricular block within the His bundle.
In three patients with congenital heart disease the site of atrioventricular (A-V) block was localized within the His bundle with the aid of His bundle electrograms. In one patient with first degree A-V block and normal QRS configuration, electrophysiologic studies revealed "split" His potentials. The other two patients had complete A-V block, and their His bundle electrograms revealed His spikes both proximal and distal to the site of block. One of the two patients, who had a pattern of left bundle branch block in the electrocardiogram, had surgically induced complete A-V block after repair of an ostium primum atrial septal defect. The other patient with congenital A-V block had a narrow QRS complex and, in addition to complete block within the His bundle, prolonged A-V nodal conduction time but no associated cardiac anomaly. Both patients with complete heart block required pacemaker insertion. The natural history of intra-H-is bundle block is not known, and it is difficult to recommend appropriate therapy. More electrophysiologic studies are needed in patients with A-V block to determine the prognostic significance of such block or conduction delay in the His bundle.
D000328:Adult; D001283:Atrioventricular Node / Q000503:physiopathology; D002036:Bundle of His / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D004558:Electric Stimulation; D004562:Electrocardiography; D005260:Female; D006327:Heart Block / Q000151:congenital / Q000503:physiopathology; D006329:Heart Conduction System / Q000503:physiopathology*; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male