Retrograde atrio-His bundle dissociation as a sign indicative of retrograde accessory pathway conduction.
Electrophysiologic study and radiofrequency ablation therapy were performed in a 36-year-old male with Wolff-Parkinson-White syndrome and Ebstein's anomaly. The study disclosed the presence of a posteroseptal accessory pathway and dual atrioventricular (AV) nodal pathways. Retrograde atrio-His bundle (A-H) dissociation was noted during rapid ventricular pacing, in which the atria were activated by retrograde impulse from the accessory pathway with a fixed ventriculo-atrial (VA) interval while the retrograde His bundle potential was visible during the diastolic isoelectric period due to the occurrence of Wenckebach periodicity within the His-Purkinje system. This phenomenon is a useful sign for rapid recognition of the accessory pathway conduction.
Wang
C H
CH
Department of Internal Medicine, Chang Gung Medical College, Taipei, Taiwan.
Yeh
S J
SJ
Wang
C C
CC
Wen
M S
MS
Lin
F C
FC
Wu
D
D
D000328:Adult; D001145:Arrhythmias, Cardiac / Q000175:diagnosis*; D002304:Cardiac Pacing, Artificial; D017115:Catheter Ablation; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male