QRS complex widening due to loss of left bundle branch capture: pitfall of para-Hisian pacing.
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.
Adachi
Masamitsu
M
Tottori University Hospital, 36-1 Nishimachi, Yonago, 6838504, Japan.
Igawa
Osamu
O
Miake
Junichiro
J
Yano
Akio
A
Inoue
Yoshiaki
Y
Ogura
Kazuyoshi
K
Kato
Masaru
M
Iitsuka
Kazuhiko
K
Hisatome
Ichiro
I
D000328:Adult; D002037:Bundle-Branch Block / Q000175:diagnosis* / Q000517:prevention & control*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D003937:Diagnosis, Differential; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D017180:Tachycardia, Ventricular / Q000175:diagnosis* / Q000517:prevention & control*