Takekuni Hayashi et al. JACEP 2016;2:27-35

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Takekuni Hayashi et al. JACEP 2016;2:27-35 Bidirectional Block Between CS and MB Connections (A) The activation sequences of the VOM were distal to proximal during the CS pacing. With the differential pacing site method, the conduction time from CS 3 to 4 to VOM 1 to 2 (270 ms) during the CS 3 to 4 pacing was longer than the conduction time from CS 7 to 8 to VOM 1 to 2 (255 ms) during the CS 7 to 8 pacing. (B) The activation sequences of CS were proximal to distal during VOM pacing. The conduction time from VOM 3 to 4 to CS 7 to 8 (255 ms) during VOM 3 to 4 pacing was longer than the conduction time from VOM 1 to 2 to CS 7 to 8 (245 ms) during VOM 1 to 2 pacing. These observations were evidence of complete bidirectional block of the CS-MB connections. Note: The conduction time from VOM 1 to 2 to LAA (160 ms) during VOM 1 to 2 pacing was shorter than the conduction time from VOM 3 to 4 to LAA (170 ms) during VOM 3 to 4 pacing. This observation suggested residual connections between the MB and LA. Furthermore, incomplete mitral isthmus block was demonstrated by the conduction time from CS 3 to 4 to LAA (145 ms) during the CS 3 to 4 pacing that was shorter than the conduction time from CS 7 to 8 to LAA (165 ms) during the CS 7 to 8 pacing. Abbreviations as in Figure 1. Takekuni Hayashi et al. JACEP 2016;2:27-35 American College of Cardiology Foundation