Clinical implications of "pure" Hisian pacing in addition to para-Hisian pacing for the diagnosis of supraventricular tachycardia

Seiji Takatsuki, Hideo Mitamura, Kojiro Tanimoto, Yukiko Fukuda, Masaki Ieda, Shunichiro Miyoshi, Kyoko Soejima, Fabrice Extramiana, Antoine Leenhardt, Satoshi Ogawa

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: Para-Hisian pacing is an effective method of differentiating between pathways for retrograde conduction over the accessory pathway (AP) and over the atrioventricular node (AVN). When performing para-Hisian pacing, the pacing spike sometimes captures only the His bundle, which we named "pure" Hisian pacing (Hc). Objective: We evaluated the significance of pure Hisian pacing for predicting the pathways of ventriculoatrial conduction. Methods: In 62 patients with supraventricular tachycardia, both para-Hisian and pure Hisian pacing were carried out during the sinus rhythm, resulting in three different types of electrocardiographic complexes with wide (local ventricular myocardial capture), slightly narrow (both local myocardial and His bundle capture), and very narrow QRS widths (Hc). A change of atrial activation sequence as demonstrated by these pacing modes indicated the presence of multiple retrograde pathways. The diagnosis of retrograde pathways by para-Hisian pacing with or without Hc was evaluated. Results: In 22 patients with AVN reentrant tachycardia, para-Hisian pacing alone was able to correctly predict ventriculo-atrial conduction exclusively through the AVN without requiring findings from Hc. In 40 AP patients, para-Hisian pacing showed a pattern of retrograde conduction through the AVN in six, through both the AVN and AP in 10, and through an AP in 24 patients. Four of these 24 patients were diagnosed as having multiple pathways (AP+AVN or dual APs) by the addition of Hc. Conclusion: Pure Hisian pacing can help disclose another pathway for retrograde conduction in AP patients, which is unpredicted by ordinary para-Hisian pacing.

Original languageEnglish
Pages (from-to)1412-1418
Number of pages7
JournalHeart Rhythm
Volume3
Issue number12
DOIs
Publication statusPublished - 2006 Dec

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Atrioventricular Node
Supraventricular Tachycardia
Bundle of His
Tachycardia

Keywords

  • Accessory pathway
  • Atrioventricular node
  • Catheter ablation
  • His bundle
  • Supraventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Clinical implications of "pure" Hisian pacing in addition to para-Hisian pacing for the diagnosis of supraventricular tachycardia. / Takatsuki, Seiji; Mitamura, Hideo; Tanimoto, Kojiro; Fukuda, Yukiko; Ieda, Masaki; Miyoshi, Shunichiro; Soejima, Kyoko; Extramiana, Fabrice; Leenhardt, Antoine; Ogawa, Satoshi.

In: Heart Rhythm, Vol. 3, No. 12, 12.2006, p. 1412-1418.

Research output: Contribution to journalArticle

Takatsuki, S, Mitamura, H, Tanimoto, K, Fukuda, Y, Ieda, M, Miyoshi, S, Soejima, K, Extramiana, F, Leenhardt, A & Ogawa, S 2006, 'Clinical implications of "pure" Hisian pacing in addition to para-Hisian pacing for the diagnosis of supraventricular tachycardia', Heart Rhythm, vol. 3, no. 12, pp. 1412-1418. https://doi.org/10.1016/j.hrthm.2006.08.028
Takatsuki, Seiji ; Mitamura, Hideo ; Tanimoto, Kojiro ; Fukuda, Yukiko ; Ieda, Masaki ; Miyoshi, Shunichiro ; Soejima, Kyoko ; Extramiana, Fabrice ; Leenhardt, Antoine ; Ogawa, Satoshi. / Clinical implications of "pure" Hisian pacing in addition to para-Hisian pacing for the diagnosis of supraventricular tachycardia. In: Heart Rhythm. 2006 ; Vol. 3, No. 12. pp. 1412-1418.
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T1 - Clinical implications of "pure" Hisian pacing in addition to para-Hisian pacing for the diagnosis of supraventricular tachycardia

AU - Takatsuki, Seiji

AU - Mitamura, Hideo

AU - Tanimoto, Kojiro

AU - Fukuda, Yukiko

AU - Ieda, Masaki

AU - Miyoshi, Shunichiro

AU - Soejima, Kyoko

AU - Extramiana, Fabrice

AU - Leenhardt, Antoine

AU - Ogawa, Satoshi

PY - 2006/12

Y1 - 2006/12

N2 - Background: Para-Hisian pacing is an effective method of differentiating between pathways for retrograde conduction over the accessory pathway (AP) and over the atrioventricular node (AVN). When performing para-Hisian pacing, the pacing spike sometimes captures only the His bundle, which we named "pure" Hisian pacing (Hc). Objective: We evaluated the significance of pure Hisian pacing for predicting the pathways of ventriculoatrial conduction. Methods: In 62 patients with supraventricular tachycardia, both para-Hisian and pure Hisian pacing were carried out during the sinus rhythm, resulting in three different types of electrocardiographic complexes with wide (local ventricular myocardial capture), slightly narrow (both local myocardial and His bundle capture), and very narrow QRS widths (Hc). A change of atrial activation sequence as demonstrated by these pacing modes indicated the presence of multiple retrograde pathways. The diagnosis of retrograde pathways by para-Hisian pacing with or without Hc was evaluated. Results: In 22 patients with AVN reentrant tachycardia, para-Hisian pacing alone was able to correctly predict ventriculo-atrial conduction exclusively through the AVN without requiring findings from Hc. In 40 AP patients, para-Hisian pacing showed a pattern of retrograde conduction through the AVN in six, through both the AVN and AP in 10, and through an AP in 24 patients. Four of these 24 patients were diagnosed as having multiple pathways (AP+AVN or dual APs) by the addition of Hc. Conclusion: Pure Hisian pacing can help disclose another pathway for retrograde conduction in AP patients, which is unpredicted by ordinary para-Hisian pacing.

AB - Background: Para-Hisian pacing is an effective method of differentiating between pathways for retrograde conduction over the accessory pathway (AP) and over the atrioventricular node (AVN). When performing para-Hisian pacing, the pacing spike sometimes captures only the His bundle, which we named "pure" Hisian pacing (Hc). Objective: We evaluated the significance of pure Hisian pacing for predicting the pathways of ventriculoatrial conduction. Methods: In 62 patients with supraventricular tachycardia, both para-Hisian and pure Hisian pacing were carried out during the sinus rhythm, resulting in three different types of electrocardiographic complexes with wide (local ventricular myocardial capture), slightly narrow (both local myocardial and His bundle capture), and very narrow QRS widths (Hc). A change of atrial activation sequence as demonstrated by these pacing modes indicated the presence of multiple retrograde pathways. The diagnosis of retrograde pathways by para-Hisian pacing with or without Hc was evaluated. Results: In 22 patients with AVN reentrant tachycardia, para-Hisian pacing alone was able to correctly predict ventriculo-atrial conduction exclusively through the AVN without requiring findings from Hc. In 40 AP patients, para-Hisian pacing showed a pattern of retrograde conduction through the AVN in six, through both the AVN and AP in 10, and through an AP in 24 patients. Four of these 24 patients were diagnosed as having multiple pathways (AP+AVN or dual APs) by the addition of Hc. Conclusion: Pure Hisian pacing can help disclose another pathway for retrograde conduction in AP patients, which is unpredicted by ordinary para-Hisian pacing.

KW - Accessory pathway

KW - Atrioventricular node

KW - Catheter ablation

KW - His bundle

KW - Supraventricular tachycardia

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