Abstract
Intracardiac catheter recordings of the specialized conducting tissue have greatly enhanced diagnostic acumen in A-V conduction disorders and disturbances of cardiac rhythm (1–9). His bundle (BH) recordings in conjunction with stimulation studies are now a clinical diagnostic tool available in an increasing number of cardiac catheterization laboratories. Such recordings of the specialized conduction system in man have both diagnostic value and are of clinical therapeutic and prognostic significance (10, 11). His bundle recordings permit a breakdown of the P-R interval into its three component conduction intervals, i.e., intra-atrial (P-A), A-V nodal (A-H), and His-Purkinje system (H-V) (12). The therapy and prognosis of A-V conduction defects may depend on the site of the lesion which cannot always be localized on the basis of the standard surface electrocardiogram. The range of a normal P-R interval is very wide (0.12–0.20 sec.) as compared to the narrow range of conduction time through the His-Purkinje system (H-V = 0.035 to 0.045 sec.) or the BH (0.015 to 0.020 sec.). The P-R interval or the QRS complex may remain within normal limits despite significant delays in the BH (even up to 200%).
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References
Narula OS, Scherlag BJ, Javier RP et al., Analysis of the A-V conduction defect in complete heart block utilizing His bundle electrograms. Circulation 41: 437, 1970.
Narula OS and Samet P: Wenckebach and Mobitz type II A-V blocks due to lesions within the His bundle and bundle branches. Circulation 41: 947, 1970.
Damato AN and Lau SH: Clinical value of the electrogram of the conduction system. Prog. Cardiovasc. Dis. 13: 119, 1970.
Puech P and Grolleau R: L’activité électrique du faisceau de His, normale et pathologique. Sandoz Pharm. Co. Paris, 1972.
Narula OS, Scherlag BJ, Samet P, et al.: Atrioventricular block: Localization and classification by His bundle recordings. Am J Med, 50: 146, 1971.
Narula OS and Samet P: Right bundle branch block with normal, left axis deviation: Analysis by His bundle recordings. Am J Med, 51: 432, 1971.
Castellanos A, Chapunoff E, Castillo C, et al.: His bundle electrograms in two cases of Wolff-Parkinson-White (pre-excitation) syndrome. Circulation, 41: 399, 1970.
Narula OS: Wolff-Parkinson-Whitesyndrome (a review). Circulation, 47: 872, 1973.
Rosen KM, Rahimtoola SH, Chuquimia R, et al.: Electrophysiological significance of first degree atrioventricular conduction disturbance. Circulation 43: 491, 1971.
Narula OS: The value of His bundle electrocardiography in cardiac diagnosis,.in Fowler No (ed): Diagnostic methods in cardiology. F.A. Davis Co. Philadelphia, 1975, p. 133.
Narula OS, Gann D, and Samet P: Prognostic value of H-Vintervals, in Narula OS (ed): His bundle electrocardiography and clinical electrophysiology. F.A. Davis, Co. Philadelphia, 1975, p. 437.
Narula OS, Cohen LS, Scherlag BJ, et al.: Localization of A-V conduction defects in man by recording of His bundle electrogram. Am J Cardiol, 25: 228, 1970.
Scherlag BJ, Lau SH, Helfant RH, et al.: Catheter technique for recording His bundle activity in man. Circulation, 39: 13, 1969.
Narula OS, Scherlag BJ and Samet P: Prevenous pacing of the specialized conducting system in man: His bundle and A-V nodal stimulation. Circulation, 41: 77, 1970.
Narula OS, Javier RP, Samet P, et al.: Significance of His and left bundle recordings from the left heart in man. Circulation 42: 385, 1970.
Narula OS, Runge M and Samet P: A new catheter technique for His bundle recordings via the arm veins. Br Heart J, 45: 1226, 1973.
Narula OS: Validation of His bundle recordings: Limitations of the catheter technique, in Narula OS (ed.): His Bundle electrocardiography and clinical electrophysiology, F.A. Davis Co. Philadelphia, 1975, p. 65.
Dhingra RL, Rosen KC, and Rahimtoola SH: Normal conduction intervals and responses in sixty-one patients using His bundle recording and atrial pacing. Chest 64: 55, 1973.
Castillo C, Castellanos S, and Agha AS: Significance of His bundle recordings with short H-V intervals. Chest 60: 142, 1971.
Damato AN, Varghese PJ, Caracta AR, Akhtar M, and Lau SH: Functional 2:1 A-V block within the His-Purkinje system: Simulation of type II second degree A-V block. Circulation 47: 534, 1973.
Narula OS: Current concepts of A-V block, in Narula OS (ed.): His bundle electrocardiography and clinical electrophysiology. F.A. Davis Co. Philadelphia, 1975, p. 139.
Narula OS, Runge M and Samet P: Second degree Wenckebach type A-V block due to block within the atrium. Br. Heart J, 34: 1127, 1972.
Narula OS, Narula JT: Junctional pacemakers in man: Response to overdrive suppression with and without parasympathetic blockade. Circulation 57: May, 1978.
Damato AN, Caracta AR, Akhtar M, and Lau SH: The effects of commonly used cardiovascular drugs on A-V-conduction and refractoriness, in Narula OS ( ed): His bundle electrocardiography and clinical electrophysiology. F.A. Davis Co. Philadelphia, 1975, p. 105.
Narula OS: Wenckebach type I and type II atrioventricular block (revisited). Cardiovasc Clin, 6 (1): 138, 1974.
Haft JI: His bundle electrogram. Circulation 47: 897, 1973.
Rosen KM: Evaluation of cardiac conduction in the cardiac catheterization laboratory. Am J Cardiol, 30: 701, 1972.
Narula OS: Longitudinal dissociation in the His bundle: Bundle branch block due to asynchronous conduction within the His bundle in man. Circulation 56: 996, 1977.
Narula OS: Intraventricular conduction defects, in Narula OS (ed.): His Bundle electrocardiography and clinical electrophysiology, F.A. Davis Co., 1975, p. 177.
Vera Z, Mason DT, Fletcher RD, Awan NA, Massumi RA: Prolonged His-Q interval in chronic bifascicular block. Relation to impending complete heart block. Circulation 53: 47, 1976.
Scheinman MM, Peters RW, Modin G, Brennan M, Mies C, Young JO: Prognostic value of intra nodal conduction time in patients with bundle branch block. Circulation 56: 240, 1977.
Denes P, Dhnigra RC, Wu D, Chuquimia R, Amat-y-leon F, Wyndham C, Rosen KM: H-V interval in patients with bifascicular block (right bundle branch and anterior hemiblock). Am J Cardiol, 35: p 23, 1975.
Lichstein E, Gupter PK, Chadda KD, Lin H, and Sayeed M: Findings of prognostic value in patients with incomplete bilateral bundle branch block completing acute myocardial infarction. Am J Card, 32: 913, 1973.
Atkins JM, Leshin SJ, Blomquist G, et al.: Ventricular conduction blocks and sudden death in acute myocardial infarction. N. Engl. J Med, 288: 281, 1973.
Narula OS and Javier RP: Sequelae of A-V block in acute myocardial infarction. Circulation (Suppl. II) 45: 197, 1972.
Narula OS, Samet P, and Javier RP: Significance of the sinus node recovery time. Circulation 45: 140, 1972.
Narula OS: Disorders of Sinus node function: Electrophysiologic evaluation, in Narula OS (ed): His Bundle electrocardiography and clinical electrophysiology. F.A. Davis Co. Philadelphia, 1975, p. 275.
Chuquimia R, Vasquez M, Qureshi T, Khan M, Towne WD, Narula OS: Effect of Propranolol on sinus node recovery time and sino-atrial conduction time. Clinical Research, 25: 3, 1977.
Strauss HC, Saroff AL, Bigger JT, Jr., etal.: Premature atrial stimulation as a key to the understanding of sino-atrial conduction in man. Circulation 47: 86, 1973.
Breithardt G, Seipel L, and Loogen F: Sinus node recovery time and calculated sinoatrial conduction time in normal subjects and patients with sinus node dysfunction. Circulation 56: 43, 1977.
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© 1978 Martinus Nijhoff Publishers by, The Hague
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Narula, O.S. (1978). Evaluation of the Cardiac Conduction System by his Bundle Recordings. In: Thalen, H.J.T., Harthorne, J.W. (eds) To Pace or not to Pace. Springer, Dordrecht. https://doi.org/10.1007/978-94-009-9723-3_6
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DOI: https://doi.org/10.1007/978-94-009-9723-3_6
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