Patterns of Atrioventricular Conduction in the Human Heart

Atrial, His bundle (H), and ventricular electrograms were recorded by an electrode catheter in unanesthetized man. Conduction time through the atrioventricular (A-V) conduction system was subdivided into A-V nodal (A-H interval) and ventricular specialized conduction system (H-V interval). The right atrium was driven at a constant rate and the pattern of A-V conduction of premature atrial test impulses was determined as they occurred progressively earlier in the cardiac cycle. In the type 1 response, conduction delay and block were limited to the A-V node only. The type 2 response was characterized by progressive conduction delay in both the A-V node and ventricular specialized conduction system with block occurring in several instances in the latter. In the type 3 response there was also a progressive delay in A-V nodal conduction time, and a sudden marked delay in conduction in the ventricular specialized conduction system. Conduction block occurred distal to the His bundle depolarization. The relevance of conduction delay and block in the different regions of the A-V conduction system to the full recovery time and the relative, functional, and effective refractory periods of A-V conduction are indicated.