Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Oct 26, 2015; 7(10): 700-702
Published online Oct 26, 2015. doi: 10.4330/wjc.v7.i10.700
Intra-His bundle block in 2:1 atrioventricular block
Seung Pyo Hong, Yon Woong Park, Young Soo Lee
Seung Pyo Hong, Yon Woong Park, Young Soo Lee, Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu 705-718, South Korea
Author contributions: Hong SP, Park YW and Lee YS designed and wrote the report; Lee YS performed the electrophysiological study and pacemaker implantation.
Institutional review board statement: This is a clinical case report. The patient related identification information has been avoided according to the policy of Daegu Catholic University Medical Center Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors have no conflict-of-interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Young Soo Lee, MD, Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, 33 Duryugongwon-ro 17-gil, Nam-gu, Daegu 705-718, South Korea. mdleeys@cu.ac.kr
Telephone: +82-53-6503441 Fax: +82-53-6213166
Received: February 20, 2015
Peer-review started: February 22, 2015
First decision: April 10, 2015
Revised: June 7, 2015
Accepted: July 16, 2015
Article in press: July 17, 2015
Published online: October 26, 2015
Processing time: 255 Days and 14.5 Hours
Abstract

Intra-hisian atrioventricular (AV) block is not a common phenomenon, but it is important for the development of advanced or complete AV block. We observed a 77-year-old female patient with the 2:1 AV block due to an intra-hisian block. In this case we tried to detect the block site, but an alternating pattern of the AH conduction was noted on the His-electrogram in the electrophysiological study (EPS). The cause of the confusing finding might have been the instability of the catheter to record a His potential. We could detect a splitting of the His-electrogram with an intra-hisian block after minimal manipulation of the catheter. The authors’ observations suggest that catheter stability is important for a precise recording in the EPS and radiofrequency catheter ablation procedure.

Keywords: Cardiac electrophysiologic techniques; Bundle of His; Atrioventricular block

Core tip: Intra-hisian atrioventricular (AV) block associated with 2:1 AV block is an uncommon phenomenon, but it is important for the development of complete AV block. We observed a 77-year-old female with 2:1 AV block due to an intra-hisian block. An alternating pattern of the AH conduction was noted on the His-electrogram. The cause of that confusing finding might have been the instability of the catheter for recording the His potential. We could detect a splitting of the His-electrogram with intra-hisian block after minimal manipulation of the catheter. The authors’ observations suggest that catheter stability is important for a precise recording.