His bundle electrocardiography in digitalis-induced "atrioventricular junctional" Wenckebach periods with irregular H-H intervals

Agustin Castellanos, Ruey J. Sung, Robert J Myerburg

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

His bundle electrograms were recorded during catheter insertion for prophylactic demand pacing in two patients with accelerated or nonaccelerated "atrioventricular (A-V) junctional" rhythms associated with A-V junctional Wenckebach periods. This appears to be the first published report of so-called A-V junctional Wenckebach periods in which the characteristic irregularities of the H-H intervals were recorded. Patient 1 had an additional area of "complete" anterograde A-V nodal (A-H) block. In Patient 2 the rate of impulse formation was consistent with nonparoxysmal A-V junctional tachycardia. The His bundle recordings were obtained in patients with digitalis toxicity and should be interpreted in that context. The integration of clinical and intracardiac findings with extrapolations from microelectrode and pharmacologic studies and with deductions from the clinical electrocardiograms suggests that the conduction disturbances probably occurred within the A-V node itself (in its AN region). This hypothesis implies that automaticity also originated in the A-V node because the site of impulse formation must have been proximal to the site of the Wenckebach periods. However, conclusive proof of these postulates will require further studies with refined techniques.

Original languageEnglish
Pages (from-to)653-656
Number of pages4
JournalThe American journal of cardiology
Volume43
Issue number3
DOIs
StatePublished - Jan 1 1979

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Bundle of His
Digitalis
Electrocardiography
Atrioventricular Node
Cardiac Electrophysiologic Techniques
Microelectrodes
Tachycardia
Catheters

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

His bundle electrocardiography in digitalis-induced "atrioventricular junctional" Wenckebach periods with irregular H-H intervals. / Castellanos, Agustin; Sung, Ruey J.; Myerburg, Robert J.

In: The American journal of cardiology, Vol. 43, No. 3, 01.01.1979, p. 653-656.

Research output: Contribution to journalArticle

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