Significance of block distal to the His bundle induced by atrial pacing in patients with chronic bifascicular block

R. C. Dhingra, C. Wyndham, R. Bauernfeind, S. Swiryn, P. C. Deedwania, T. Smith, P. Denes, K. M. Rosen

Research output: Contribution to journalArticle

108 Scopus citations

Abstract

Twenty-one of 496 (4%) patients with chronic bifascicular block, studied and followed prospectively, had block distal to the His bundle (BDH) induced by atrial pacing during initial electrophysiologic studies. In six, BDH was noted during pacing-induced atrioventricular (AV) nodal Wenckebach periods (at paced rates of 150-190 beats/min), with BDH in the short HH cycles after the AV nodal blocked P (long cycle). The AH interval was normal in all six patients and HV was normal in four. None of the six patients has developed AV block during a mean follow-up of 5.33 ± 0.59 years, seven of these patients developed AV block, one had treadmill-provoked AV block, and two died suddenly (major morbid event in 10 of 15 patients). In conclusion, BDH induced by atrial pacing is an infrequent finding in patients with bifascicular block, and can be a functional as well as a pathologic response. The latter is associated with a high risk of major morbid events (AV block and sudden death).

Original languageEnglish (US)
Pages (from-to)1455-1464
Number of pages10
JournalCirculation
Volume60
Issue number7
DOIs
StatePublished - Jan 1 1979

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Dhingra, R. C., Wyndham, C., Bauernfeind, R., Swiryn, S., Deedwania, P. C., Smith, T., Denes, P., & Rosen, K. M. (1979). Significance of block distal to the His bundle induced by atrial pacing in patients with chronic bifascicular block. Circulation, 60(7), 1455-1464. https://doi.org/10.1161/01.CIR.60.7.1455