title: QRS complex widening due to loss of left bundle branch capture: pitfall of para-Hisian pacing.
abstract: 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.
authors.affiliation: Tottori University Hospital, 36-1 Nishimachi, Yonago, 6838504, Japan.
authors.forename: Masamitsu
authors.initials: M
authors.lastname: Adachi
authors.forename: Osamu
authors.initials: O
authors.lastname: Igawa
authors.forename: Junichiro
authors.initials: J
authors.lastname: Miake
authors.forename: Akio
authors.initials: A
authors.lastname: Yano
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Inoue
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Ogura
authors.forename: Masaru
authors.initials: M
authors.lastname: Kato
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Iitsuka
authors.forename: Ichiro
authors.initials: I
authors.lastname: Hisatome
mesh_terms: 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*