Atrial tachycardia (AT) originating from the aortomitral junction is a very rare and challenging disease. Its arrhythmic characteristics have not been described in detail compared with the descriptions of the arrhythmic characteristics of AT originating from the other locations. Only a few case reports have documented successful ablation of this type of AT using transaortic or transseptal approaches. We describe a case with AT that was resistant to right-sided ablation near the His bundle failed and transaortic ablation at the aortomitral junction successfully eliminated.
Bundle of His ; Catheter Ablation ; Tachycardia*

Clinical electrophysilogical study(EPS) was done in 5 patients with chronic bifascicular block of completa RBBB and left anterior fascicular block. The results were as follows. 1) In 2 patients who needed permenent pacemaker therapy, EPS disclosed prolonged HV interval(>70msec) and block distal to his bundle by atrial with cycle length of longer than 545msec. 2) In 3 patients who didn't need permenent pacemaker therapy, AV conduction and to choose the therapeutic measures in the patients with chronic bifascicular block and unexplained dizziness and/or syncope.
Bundle of His ; Bundle-Branch Block ; Dizziness ; Humans ; Syncope

A contralateral bundle branch block (BBB) aberration during tachycardia with a preexisting BBB strongly suggests the presence of ventricular tachycardia. We report on a middle-aged, female patient presented with wide QRS tachycardia. The patient had orthodromic atrioventricular tachycardia with a left BBB aberration in the presence of a preexisting right BBB due to an abnormal His-Purkinje system. We learned that the contralateral BBB aberration with supraventricular tachycardia could be seen when the His-Purkinje system was abnormal.
Bundle of His ; Bundle-Branch Block* ; Female ; Humans ; Purkinje Fibers ; Tachycardia ; Tachycardia, Supraventricular* ; Tachycardia, Ventricular

Accessory Atrioventricular Bundle ; Bundle of His ; surgery ; Child ; Cryosurgery ; Humans ; Wolff-Parkinson-White Syndrome

Bundle of His ; Bundle-Branch Block ; Cardiac Pacing, Artificial ; Electrocardiography ; Humans ; Purkinje Fibers

Bundle of His ; Bundle-Branch Block/therapy* ; Cardiac Pacing, Artificial ; Electrocardiography ; Heart Conduction System ; Heart Failure/therapy* ; Humans

BACKGROUND AND OBJECTIVES: Atrial fibrillation (AF) has long been recognized as a random phenomenon. Recent studies, however, suggest that activation sequence during atrial fibrillation is not entirely disorganized and organized activations as the transitional rhythm exists in the process of conversion from atrial fibrillation to atrial flutter. The purpose of this study is to characterize the process and significance of transitional rhythm during conversion of atrial fibrillation to atrial flutter. MATERIALS AND METHODS: In 9 patients with paroxysmal atrial fibrillation, 13 episodes that atrial fibrillation spontaneously converted to atrial flutter during electrophysiological study were analyzed. To map the right atrium (RA), 10 bipolar Halo catheter was positioned in the lateral free wall of the RA and multielectrode catheters were positioned in the coronary sinus, high RA, and His bundle area, respectively. Calculation of cycle length (CL) was performed with digital caliper during atrial fibrillation and atrial flutter. Direction of activation sequences was compared between transitional rhythm and following atrial flutter. RESULTS: During conversion of atrial fibrillation to atrial flutter, characteristic findings were observed as follows. 1) There was a gradual increase in atrial fibrillation cycle length before transitional rhythm. 2) A pause appeared in atrial fibrillation immediately prior to transitional rhythm, and between transitional rhythm and following atrial flutter. 3) Direction of activation sequences of the transitional rhythm to atrial flutter was concordant in 9 episodes and discordant in 4 episodes. 4) Spontaneous termination of atrial flutter (n=3) was also preceded by organized rhythm showing different sequence of activations from those of atrial flutter. CONCLUSION: A stereotypical pattern of activation sequence exists in the process of conversion of atrial fibrillation to atrial flutter. The occurrence of transitional rhythm influences the activation sequence of atrial flutter. Spontaneous termination of atrial flutter also preceded by transiently changing pattern of activation.
Atrial Fibrillation* ; Atrial Flutter* ; Bundle of His ; Catheters ; Coronary Sinus ; Heart Atria ; Humans

His bundle recordings enable us to diagnose conduction disturbances not discernable in the standard leads, and to localize conduction block in the subdivisions of the conduction system. Cases of intra-His bundle block were first reported in 1970 by Narula and Samet. Thereafter many additional reports and studies were made. We report a case of 3degrees A-V block due to conduction block at the His bundle level. A 71-year-old woman was admitted because of dizziness. Surface ECG showed 3degrees A-V block. His bundle electrogram revealed typical split His potential. A-H intervals were 80 msec and H'-V intervals 50~70 msec. And there found no relation between AH and H'A. Atrial pacing resulted only prolongation of A-H to 90 msec but dissociation between h and H' was consistent. We implanted a permanent endocardial pacemaker in her chest.
Aged ; Bundle of His ; Dizziness ; Electrocardiography ; Electrophysiologic Techniques, Cardiac ; Female ; Humans ; Thorax

Catheter ablation is performed in selected patients with a symptomatic premature ventricular complex (PVC) or PVC-induced cardiomyopathy. Ablation of PVC from the His region has a high risk of inducing a complete atrioventricular block. Here we report successful catheter ablation of a parahisian PVC in a 63-year-old man.
Atrioventricular Block ; Bundle of His ; Cardiomyopathies ; Catheter Ablation ; Catheters ; Humans ; Middle Aged ; Ventricular Premature Complexes

AIMTo evaluate the effects of atria-His bundle sequential pacing on cardiac electrophysiology and heamodynamics in dogs.

METHODSIn 20 opening chest anesthetized dogs, platinum electrodes were fixed at the epicardium of right atria (RA) and the right ventricular apex (RVA) respectively, pacing right atria and the right ventricle. A special lead was located at His bundle (based on a optical "H" wave and narrow duration of the QRS complexes recorded in ECG), pacing His bundle. Cardiac electrophysiology and hemodynamics parameters were compared in the different pacing models RA(AAI, RVA-(VVI), HisB-(VVI) single chamber pacing and RA-RVA(DDI), RA-HisB(DDI) dual chamber pacing.

RESULTSThe threshold of His B pacing is similar to that of RVA pacing. Cardiac output (CO) is increased in pacing of RA(AAI), His B-(VVI) and RA-His B(DDI). It is increased by 29.64% in pacing of RA-His B(DDI) (P < 0.01) and by 0.25% (P > 0.05) in pacing of RA-RVA(DD1) While CO is decreased by 5.41% in RVA-VVI) pacing (P > 0.05). SV, LVSW and RVSW of RA-HisB(DDI) pacing are superior to those in RVA-VVI) and RA-RVA(DDI) pacing.

CONCLUSIONRight atria-His bundle sequence pacing significantly improves cardiac function compared with the other model pacing because it maintains normal physiological electronic activity sequence and systolic synchrony. It will be adapted to clinical application.

Animals ; Bundle of His ; physiology ; Cardiac Electrophysiology ; Cardiac Pacing, Artificial ; methods ; Dogs ; Female ; Heart Atria ; Hemodynamics ; Male