New diagnostic finding to assess para-Hisian pacing observed in a patient with a permanent form of junctional reciprocating tachycardia.
Para-Hisian pacing, a useful method to differentiate conduction over an accessory pathway from conduction over the AV node, is assessed essentially by comparing the timing of local atrial electrograms between His-bundle captured beats and His-bundle noncaptured beats. We describe the case of a patient with a permanent form of junctional reciprocating tachycardia, in whom an atrial double potential was recorded only during the tachycardia at the right posterior septum. During para-Hisian pacing, a morphologic change in the atrial electrogram at the posterior septum was also identified, as well as a change in the retrograde atrial sequence. Since the morphologic change of atrial electrograms during para-Hisian pacing cannot be demonstrated in a patient without an accessory pathway, this new finding could be considered a new additional diagnostic criterion suggesting the presence of an accessory pathway.
Hirao
K
K
First Department of Internal Medicine, School of Medicine, Tokyo Medical and Dental University, Japan. 0160.med1@med.tmd.ac.jp
Toshida
N
N
Kawabata
M
M
Motokawa
K
K
Suzuki
F
F
Hiejima
K
K
D000328:Adult; D002036:Bundle of His / Q000503:physiopathology; D002304:Cardiac Pacing, Artificial / Q000379:methods; D004562:Electrocardiography; D006325:Heart Atria / Q000503:physiopathology; D006329:Heart Conduction System / Q000002:abnormalities / Q000503:physiopathology*; D006801:Humans; D008297:Male; D013610:Tachycardia / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology*