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His–Purkinje system longitudinal dissociation: From bench to bedside. A case of output‐dependent fascicular capture
Author(s) -
Marinaccio Leonardo,
Vetta Francesco,
Ignatiuk Barbara,
Giacopelli Daniele,
Patrassi Luigia A.,
Marchese Domenico
Publication year - 2021
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.14964
Subject(s) - medicine , qrs complex , bundle , left bundle branch block , dissociation (chemistry) , cardiology , bundle branch block , anatomy , electrocardiography , heart failure , chemistry , materials science , composite material
: Histological studies reported that the His bundle (HB) is partitioned into narrow cords by collagen running in its long axis, providing the anatomical setting necessary for its longitudinal dissociation. Further confirmations came from the demonstration that direct HB pacing normalizes the QRS axis and duration in subjects with proximal HB lesions causing bundle branch block. However, there is no evidence of the possibility of selective HB partitions pacing destined to the composition of branches and fascicles. Methods and Results : We describe a case of intra‐Hisian left bundle branch block in which permanent distal HB pacing corrects left ventricular delay and produces different QRS morphology at different voltage outputs, as an expression of different selective HB compartments recruitment. Conclusion : This case would strengthen the limited data in the literature about HB longitudinal dissociation.