Left Bundle Branch Block Tachycardia in a Case of Dextrocardia: What Is the Mechanism?

Sorgente, Antonio; Ali, Hussam; Pittalis, Mario; Cappato, Riccardo

doi:10.1111/jce.12256

Cited by 1 publication

(2 citation statements)

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“…It is important to understand certain limitations before concluding based on PHP. 5 , 8 , 11 – 24 A common misconception about PHP is that it is useful only for septal APs. 25 However, even with left or right lateral APs, as long as pacing from the para-Hisian region conducts to the atrium with the RAA sequence being analyzed, this maneuver can be used to determine whether that activation is AV node–dependent or AP-dependent.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, at very high-output pacing, direct capture of the contralateral bundle (left bundle or left ventricular myocardium) can create earlier activation via a left-sided pathway, with high-output pacing giving a mistaken impression of retrograde AV node activation. 17 , 18 , 24 After this extranodal response to the PHP maneuver, an orthodromic AV re-entrant tachycardia using the left posterolateral AP was diagnosed, and the posterolateral AP was ablated with satisfactory results.…”

Section: Discussionmentioning

confidence: 99%

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Paradoxical Para-Hisian Pacing Response

EFE,

MEROVCI,

CALAPKULU

et al. 2023

J Innov Cardiac Rhythm Manage.

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Para-Hisian pacing (PHP) is among the most useful maneuvers in cardiac electrophysiology during sinus rhythm and identifies whether retrograde conduction is dependent on the atrioventricular (AV) node. In this maneuver, the retrograde activation time and pattern are compared during capture and loss of capture of the His bundle while pacing from a para-Hisian position. A common misconception about PHP is that it is useful only for septal accessory pathways (APs). However, even with left or right lateral pathways, as long as pacing from the para-Hisian region conducts to the atrium with the activation sequence being analyzed, it can be used to determine whether that activation is AV node–dependent or AP-dependent.

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