HeartRhythm Case Reports

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Abnormal epicardial electrophysiologic substrate in patients with early repolarization pattern and reduced left ventricular systolic function: A report.

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TWELVE-LEAD INTERPRETATION

HeartRhythm Case Reports

Circ Arrhythm Electrophysiol

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Ablation of ventricular tachycardia from the aortic root after transcatheter aortic valve replacement Uma N. Srivatsa, MBBS, MAS, FHRS, Eric J. Nordsieck,

His-bundle pacing in a patient with dextrocardia, severe systolic dysfunction, and complete atrioventricular block Manuel Molina-Lerma, MD, Juan Jiménez-Jáimez,

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Volume 15, Issue 1, Pages (January 2018)

Premature ventricular contractions with two QRS morphologies originate from one focus in great cardiac vein Juan Ma, MD, Ke-Xiang Wu, MD, Yu-Bin Wang,

Efficacy of a pure Ikr blockade with nifekalant in refractory neonatal congenital junctional ectopic tachycardia and careful attention to damaging the.

Prakash G. Suryanarayana, MD, David S. Frankel, MD, FHRS, Francis E

Challenges in the diagnosis and management of idiopathic ventricular fibrillation Jonathan Lipton, MD, PhD, George J. Klein, MD, Raymond W. Sy, MBBS,

Irregular wide QRS complex tachycardia in a patient with pulmonary hypertension: What is the mechanism? Abigail Louise D. Te, MD, Fa-Po Chung, MD, Yenn-Jiang.

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Limitations of 12-lead electrocardiogram wide complex tachycardia algorithms in a patient with left atrial flutter and large myocardial infarction Carlos.

Dual-loop biatrial concomitant macroreentrant tachycardia in a patient without previous history of surgery or ablation Song-Yun Chu, MD, Li-Bin Shi,

Unusual mechanism of complete atrioventricular block following atrial flutter ablation Frederic Georger, MD, Luc De Roy, MD, Camelia Sorea, Jean-Paul.

Pseudo typical atrial flutter occurring after cavotricuspid isthmus ablation in a patient with a prior history of Senning operation Naoki Yoshida, MD,

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QRS normalization during atrial pacing in a patient with complete left bundle branch block: What is your diagnosis? Oholi Tovia-Brodie, MD, Yoav Michowitz,

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Overcoming left bundle branch block by permanent His bundle pacing: Evidence of longitudinal dissociation in the His via recordings from a permanent pacing.

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HeartRhythm Case Reports

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Successful fluoroless ablation of an incessant atypical atrial flutter attributed to AtriClip usage during mini-MAZE surgery for persistent atrial fibrillation

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Atrioventricular block at the distal His bundle: Electrophysiological insights from left bundle branch pacing Pugazhendhi Vijayaraman, MD, FHRS, Weijian.

Two apparently remote types of ventricular tachycardia from a single right bundle branch focal source Jaromír Josiek, MD, Jaroslav Januška, MD, PhD,

Ablation of a symptomatic spontaneous automatic focus arising from an atriofascicular fiber Sandrine Venier, MD, Paul Khairy, MD, PhD, Bernard Thibault,

Recurrent polymorphic ventricular tachycardia initiated by Purkinje ectopy in a patient with cardiac sarcoidosis Faisal Matto, MD, Mohsan Chaudhry, MD,

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Resolution of new left bundle branch block and ventricular tachycardia with immunosuppressive therapy in a patient with cardiac sarcoidosis Aatish Garg,

Volume 12, Issue 2, Pages (February 2015)

Jeffrey Munro, DO, Win-Kuang Shen, MD, FHRS, Komandoor Srivathsan, MD

A wide QRS complex tachycardia utilizing an atypical accessory pathway in latent Wolff- Parkinson-White syndrome: Manifestation of anterograde conduction.

Presentation transcript:

HeartRhythm Case Reports Permanent left posterior fascicular area pacing through the interventricular septum in a patient with infra-Hisian block Li-Jun Zeng, MD, Yun-Qiu Jiang, MD, Yan-Jiang Wang, MD, Liang Shi, MD, Ying Tian, MD, Xing-Peng Liu, MD HeartRhythm Case Reports DOI: 10.1016/j.hrcr.2019.04.011 Copyright © 2019 Heart Rhythm Society Terms and Conditions

Figure 1 Twelve-lead electrocardiography (ECG) and intracardiac electrograms of the patient. A: Baseline ECG showed sinus rhythm, 2:1 atrioventricular block, and right bundle branch block. The arrow indicates the P wave. B–D: From top to bottom, the image shows leads I, II, III, aVR, aVL, aVF, and V1 and the intracardiac electrograms recorded by the 3830 lead. B: The prolonged HV interval was 242 ms in conducted sinus beats, and the following nonconducted sinus beats showed atrio-His (AH) block. C: The impulses were not conducted to the ventricle during pacing from the His bundle region. D: A sharp Purkinje (P) potential with normal P to ventricular interval was recorded deep in the interventricular septum. The sweep speed of the tracing in A and in B–D was 25 mm/s and 100 mm/s, respectively. A = atrial electrogram; V = ventricular electrogram. HeartRhythm Case Reports DOI: (10.1016/j.hrcr.2019.04.011) Copyright © 2019 Heart Rhythm Society Terms and Conditions

Figure 2 Lead position determined by fluoroscopy and echocardiography. A: The angiography performed using the C315 sheath in the anteroposterior view. B: Fluoroscopic image in the right anterior oblique view. C: Four-chamber view in echocardiography. The yellow double arrow shows interventricular septum. The white arrow shows the 3830 ventricular lead. IVS = interventricular septum; RAA = right atrial appendage. HeartRhythm Case Reports DOI: (10.1016/j.hrcr.2019.04.011) Copyright © 2019 Heart Rhythm Society Terms and Conditions

Figure 3 Twelve-lead electrocardiography during unipolar and bipolar pacing, respectively. A: Unipolar pacing resulted in delayed right ventricular activation. The arrow shows a QR pattern in V1. B: Bipolar pacing showed attenuated R wave in V1. The left axis deviation in both electrocardiograms indicated left anterior fascicular block. HeartRhythm Case Reports DOI: (10.1016/j.hrcr.2019.04.011) Copyright © 2019 Heart Rhythm Society Terms and Conditions