Affiliation:
1. From the Cardiopulmonary Laboratory, U.S. Public Health Service Hospital, Staten Island, New York.
Abstract
Re-entry within the His-Purkinje system (HPS) was consistently observed in 15/24 consecutive patients in whom retrograde refractory period studies were performed using His bundle electrograms and the ventricular extrastimulus method. Within a narrow range of ventricular coupling intervals (V
1
V
2
), V
2
retrogradely conducted to the bundle of His (H
2
) with significant infra-His bundle conduction delay (V
2
H
2
interval). At critical V
2
H
2
delays another beat of ventricular origin (V
3
) followed V
2
and was associated with H
2
V
3
intervals greater than the H-V intervals of sinus beat. It is postulated that V
2
retrogradely blocked within the right bundle branch and activated the bundle of His via the left bundle branch after which antegrade conduction occurred along the right bundle branch producing the V
3
response. In support of re-entry within the HPS are the following: 1) V
3
occurred in a narrow range of V
1
V
2
intervals and critical V
2
H
2
delays, 2) V
3
did not occur when V
2
retrogradely blocked below the bundle of His, 3) V
3
was independent of retrograde A-V nodal delay, 4) V
3
rarely occurred in patients with pre-existing complete right bundle branch block pattern. These results reasonably exclude local re-entry near the site of stimulation.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Physiology (medical),Cardiology and Cardiovascular Medicine
Cited by
209 articles.
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