An unusual cause of HV prolongation

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An unusual cause of HV prolongation Gerard Loughlin, MD, Jonathan Dukes, MD, Nitish Badhwar, MD, FHRS HeartRhythm Case Reports Volume 2, Issue 6, Pages 459-461 (November 2016) DOI: 10.1016/j.hrcr.2015.03.020 Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 1 Surface electrocardiogram with serum potassium levels at 6.8 mEq/L (top) and at 4.4 mEq/L (bottom). Note the prolongation of the PR (292 ms) and QRS (225 ms) intervals during hyperkalemia compared with normokalemia (PR 221 ms, QRS 183 ms). QRS in both cases has an atypical right bundle branch block morphology with a right superior axis. HeartRhythm Case Reports 2016 2, 459-461DOI: (10.1016/j.hrcr.2015.03.020) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 2 Intracardiac tracings with serum potassium levels (K) at 6.8 mEq/L (left) and 4.4 mEq/L (right). From top to bottom: surface electrocardiogram leads, His bundle recordings. Note the prolongation of the HV interval (119 ms), which decreases (78 ms) on correction of hyperkalemia. His bundle electrocardiogram is singled out with a red arrow: QRS onset (marked by the vertical red line) is earliest in V2. HeartRhythm Case Reports 2016 2, 459-461DOI: (10.1016/j.hrcr.2015.03.020) Copyright © 2016 Heart Rhythm Society Terms and Conditions