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His Bundle Extrasystoles Revisited: The Great Electrocardiographic Masquerader
Author(s) -
AMEEN ABDUL,
DHARAWAT AMITA,
KHAN ABDULLAH,
TURITTO GIOIA,
ELSHERIF NABIL
Publication year - 2011
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2010.02772.x
Subject(s) - medicine , presyncope , cardiology , electrocardiography , syncope (phonology) , atrioventricular block , right bundle branch block , bundle branch block , heart rate , blood pressure
A 74‐year‐old man with past history of near syncope presented with frequent periods of second‐degree atrioventricular block (2° AVB). An electrophysiological study revealed prolonged atrial‐His and His‐ventricular (HV) intervals and frequent His bundle (H) extrasystoles. The latter manifested in the surface electrocardiogram as premature atrial, junctional, or ventricular beats, as well as 2° AVB that mimicked Wenckebach or Mobitz II block. Procainamide markedly suppressed H extrasystole. However, because of the presence of prolonged HV interval and history of presyncope, a permanent pacemaker was inserted. The case illustrates the varied manifestation of H extrasystole and presents guidelines for management. (PACE 2011; e56–e59)