Document Detail

Significance of block distal to the His bundle induced by atrial pacing in patients with chronic bifascicular block.
MedLine Citation:
PMID:  498473     Owner:  NLM     Status:  MEDLINE    
Twenty-one of 496 (4%) patients with chronic bifascicular block, studied and followed prospectively, had block distal to the His bundle (BDH) induced by atrial pacing during initial electrophysiologic studies. In six, BDH was noted during pacing-induced atrioventricular (AV) nodal Wenckebach periods (at paced rates of 150--190 beats/min), with BDH in the short HH cycles after the AV nodal blocked P (lond cycle). The AH interval was normal in all six patients and HV was normal in four. None of the six patients has developed AV block during a mean follow-up of 5.33 +/- 0.48 years. In 15 patients, pacing-induced BDH was noted during intact AV nodal conduction (paced rate of 80--200 beats/min). The AH interval was prolonged in one, and HV was prolonged in 10 of the 15 patients. During a mean follow-up of 3.4 +/- 0.59 years, seven of these patients developed AV block, one had treadmill-provoked AV block, and two died suddenly (major morbid event in 10 of 15 patients). In conclusion, BDH induced by atrial pacing is an infrequent finding in patients with bifascicular block, and can be a functional as well as a pathologic response. The latter is associated with a high risk of major morbid events (AV block and sudden death).
R C Dhingra; C Wyndham; R Bauernfeind; S Swiryn; P C Deedwania; T Smith; P Denes; K M Rosen
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Circulation     Volume:  60     ISSN:  0009-7322     ISO Abbreviation:  Circulation     Publication Date:  1979 Dec 
Date Detail:
Created Date:  1980-01-28     Completed Date:  1980-01-28     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1455-64     Citation Subset:  AIM; IM    
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MeSH Terms
Atrioventricular Node / physiopathology
Bundle of His / physiopathology*
Bundle-Branch Block / physiopathology*
Chronic Disease
Heart Conduction System / physiopathology*
Middle Aged
Pacemaker, Artificial*
Purkinje Fibers / physiopathology
Time Factors

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