Linking: a dynamic electrophysiologic phenomenon in macroreentry circuits.

Lehmann, Michael H.; Denker, Stephen; Mahmud, Rehan; Addas, Abdulrahman; Akhtar, Masood

doi:10.1161/01.cir.71.2.254

Cited by 76 publications

(32 citation statements)

References 39 publications

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“…The interruption of aberrant conduction by a single PVC is highly indicative of a «linking» phenomenon as the underlying mechanism with repetitive concealed retrograde penetration of the left bundle by impulses propagating anterogradely through the right bundle. Linking phenomenon has been used to indicate the mechanism for perpetuation of functional anterograde bundle branch block by repetitive transseptal retrograde concealed penetration by impulses propagating along the contralateral bundle [1].…”

Section: Discussionmentioning

confidence: 99%

Intermittent Left Bundle Branch Block: What is the Mechanism?

Ali¹

2017

J Cardiol Cardiovasc Med

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A 73-year-old male underwent cardiologic evaluation for an incidental electrocardiographic inding of left bundle branch block (LBBB). He was asymptomatic and had no relevant cardiac history. Physical examination and transthoracic echocardiogram revealed no abnormalities.12-lead Holter ECG showed constant sinus rhythm, preserved AV conduction (PR at the upper normal limit) and no brady/tachyarrhythmias. Complete LBBB was observed during prolonged phases of the recording, but occasionally it was intermittent ( Figure 1). What is the most likely mechanism of the intermittent LBBB showed in this igure? DISCUSSIONThe irst half of the igure showed 12-lead ECG with sinus rhythm at 65 bpm conducted with complete LBBB (QRS duration ≈ 160 ms) and PR interval at the upper

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Section: Discussionmentioning

confidence: 99%

Intermittent Left Bundle Branch Block: What is the Mechanism?

Ali¹

2017

J Cardiol Cardiovasc Med

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“…The most widely accepted explanation of alternating aberration during supraventricular bigeminy involves the following principles: (1) Cycle--length dependency of the refractory periods within the His-Purkinje system (Ashman phenomenon). A relatively long cycle is followed by a relatively long refractory period and a relatively short cycle is followed by a relatively short refractory period; (2) Linking or transseptal retrograde concealed conduction or retrograde invasion of the blocked bundle (exhibiting delayed or blocked conduction) by the impulse from the contralateral bundle branch that conducts [5]. The ladder diagram in Figure 2 illustrates these concepts [3].…”

Section: Discussionmentioning

confidence: 99%

Alternating bundle branch block during atrial bigeminy

Barold¹,

Herweg²

2012

Cardiol J

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Alternate patterns of ventricular excitation may occur with any type of supraventricular bigeminy. It is a physiologic phenomenon that depends on the rate dependency of bundle-branch refractoriness and the linking phenomenon related to concealed retrograde penetration of aberrantly conducted beats into their own blocked bundle branch [1][2][3]. An alternate pattern of ventricular activation can only occurs if the coupling intervals of the early atrial premature complexes, the refractory periods of the bundle branches, and the anterograde and retrograde conduction times within the bundles present a favorable combination of factors critical for alternation of ventricular activation. Figure 1 is an ECG of lead V1 showing atrial bigeminy with alternating bundle branch block in a 20 year-old woman without heart disease who complained of a skipping sensation in her chest. The coupling intervals of all the atrial extrasystoles were identical. The QRS complex during right bundle branch block (RBBB) is slightly longer than 0.12 s with careful scrutinity of the initial forces best seen in the last complex [4]. DiscussionAlternating bundle branch block (in contrast to alternating degrees of aberration [2]) during spontaneous atrial bigeminy has rarely been reported [1][2][3]. The most widely accepted explanation of alternating aberration during supraventricular bigeminy involves the following principles: (1) Cycle--length dependency of the refractory periods within the His-Purkinje system (Ashman phenomenon). A relatively long cycle is followed by a relatively long refractory period and a relatively short cycle is followed by a relatively short refractory period; (2) Linking or transseptal retrograde concealed conduction or retrograde invasion of the blocked bundle (exhibiting delayed or blocked conduction) by the impulse from the contralateral bundle branch that conducts [5]. The ladder diagram in Figure 2 illustrates these concepts [3]. The broken lines represent anterograde and retrograde conduction over the right bundle branch; shaded bars represent the refractory periods of the right bundle. Continuous lines and empty bars indicate left bundle-branch

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“…1 The linking phenomenon has many variations because of the many types of macroreentrant tachycardia found in humans. We certainly observed this phenomenon in dual AVN pathways.…”

Section: Discussionmentioning

confidence: 99%

“…1 Recent studies of both the electrophysiological properties of the atrioventricular node (AVN) and radiofrequency catheter ablation treatment of AVN reentrant tachycardia (AVNRT) have indicated the presence of dual AVN pathways; namely, fast and slow pathways that are located at the anterior and posterior portions, respectively, of the compact node near the coronary sinus orifice. [2][3][4][5] The present study investigated the linking phenomenon in patients with dual AVN pathways and the electrophysiological mechanism is discussed.…”

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confidence: 99%