Catheter induced distal intra-Hisian right bundle branch block in a patient with persistent proximal intra-Hisian complete A-V block.
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.
D000368:Aged; D002036:Bundle of His / Q000503:physiopathology; D002037:Bundle-Branch Block / Q000209:etiology*; D006328:Cardiac Catheterization / Q000009:adverse effects*; D004562:Electrocardiography; D005260:Female; D006327:Heart Block / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D010138:Pacemaker, Artificial