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Evaluation of the Cardiac Conduction System by his Bundle Recordings

  • Onkar S. Narula

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%).

Keywords

Sinus Node Atrial Pace Complete Heart Block Right Bundle Branch Block Sinus Node Dysfunction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    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.PubMedGoogle Scholar
  2. 2.
    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.PubMedGoogle Scholar
  3. 3.
    Damato AN and Lau SH: Clinical value of the electrogram of the conduction system. Prog. Cardiovasc. Dis. 13: 119, 1970.PubMedCrossRefGoogle Scholar
  4. 4.
    Puech P and Grolleau R: L’activité électrique du faisceau de His, normale et pathologique. Sandoz Pharm. Co. Paris, 1972.Google Scholar
  5. 5.
    Narula OS, Scherlag BJ, Samet P, et al.: Atrioventricular block: Localization and classification by His bundle recordings. Am J Med, 50: 146, 1971.PubMedCrossRefGoogle Scholar
  6. 6.
    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.Google Scholar
  7. 7.
    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.PubMedGoogle Scholar
  8. 8.
    Narula OS: Wolff-Parkinson-Whitesyndrome (a review). Circulation, 47: 872, 1973.PubMedGoogle Scholar
  9. 9.
    Rosen KM, Rahimtoola SH, Chuquimia R, et al.: Electrophysiological significance of first degree atrioventricular conduction disturbance. Circulation 43: 491, 1971.PubMedGoogle Scholar
  10. 10.
    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.Google Scholar
  11. 11.
    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.Google Scholar
  12. 12.
    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.PubMedCrossRefGoogle Scholar
  13. 13.
    Scherlag BJ, Lau SH, Helfant RH, et al.: Catheter technique for recording His bundle activity in man. Circulation, 39: 13, 1969.Google Scholar
  14. 14.
    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.Google Scholar
  15. 15.
    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.PubMedGoogle Scholar
  16. 16.
    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.CrossRefGoogle Scholar
  17. 17.
    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.Google Scholar
  18. 18.
    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.PubMedCrossRefGoogle Scholar
  19. 19.
    Castillo C, Castellanos S, and Agha AS: Significance of His bundle recordings with short H-V intervals. Chest 60: 142, 1971.PubMedCrossRefGoogle Scholar
  20. 20.
    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.PubMedGoogle Scholar
  21. 21.
    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.Google Scholar
  22. 22.
    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.PubMedCrossRefGoogle Scholar
  23. 23.
    Narula OS, Narula JT: Junctional pacemakers in man: Response to overdrive suppression with and without parasympathetic blockade. Circulation 57: May, 1978.Google Scholar
  24. 24.
    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.Google Scholar
  25. 25.
    Narula OS: Wenckebach type I and type II atrioventricular block (revisited). Cardiovasc Clin, 6 (1): 138, 1974.Google Scholar
  26. 26.
    Haft JI: His bundle electrogram. Circulation 47: 897, 1973.PubMedGoogle Scholar
  27. 27.
    Rosen KM: Evaluation of cardiac conduction in the cardiac catheterization laboratory. Am J Cardiol, 30: 701, 1972.Google Scholar
  28. 28.
    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.PubMedGoogle Scholar
  29. 29.
    Narula OS: Intraventricular conduction defects, in Narula OS (ed.): His Bundle electrocardiography and clinical electrophysiology, F.A. Davis Co., 1975, p. 177.Google Scholar
  30. 30.
    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.PubMedGoogle Scholar
  31. 31.
    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.PubMedGoogle Scholar
  32. 32.
    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.Google Scholar
  33. 33.
    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.PubMedCrossRefGoogle Scholar
  34. 34.
    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.PubMedCrossRefGoogle Scholar
  35. 35.
    Narula OS and Javier RP: Sequelae of A-V block in acute myocardial infarction. Circulation (Suppl. II) 45: 197, 1972.Google Scholar
  36. 36.
    Narula OS, Samet P, and Javier RP: Significance of the sinus node recovery time. Circulation 45: 140, 1972.PubMedGoogle Scholar
  37. 37.
    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.Google Scholar
  38. 38.
    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.Google Scholar
  39. 39.
    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.PubMedGoogle Scholar
  40. 40.
    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.PubMedGoogle Scholar

Copyright information

© Martinus Nijhoff Publishers by, The Hague 1978

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  • Onkar S. Narula

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