Absent ventriculo-atrial conduction during right ventricular apical pacing but nodal response during para-Hisian pacing – What is the mechanism?

Q3 Medicine Indian Pacing and Electrophysiology Journal Pub Date : 2024-01-01 DOI:10.1016/j.ipej.2023.12.002

Debabrata Bera , Sanjeev S. Mukherjee , Ashesh Halder , Saroj Kumar Choudhury

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Abstract

A 13-year-old-girl presented with one episode of pre-syncope while standing in a train. Her ECG was suggestive of preexcitation. Echocardiography revealed structurally normal heart without any ventricular hypertrophy. During electrophysiology study, her ventriculo-atrial (VA) conduction was absent even on isoprenaline. However, a para-Hisian pacing maneuver (PHP) revealed consistent VA conduction with a nodal response. This finding indicated that the VA dissociation at baseline was at infra-Hisian (VH) level and conduction at HA level was intact. In addition, this finding is coherent with a speculation of a fasciculo-ventricular pathway (FVP) resulting in such an ECG pattern in her. Pacing from various atrial sites (right atrium, coronary sinus) exhibited nearly fixed preexcitation and short non-varying HV interval confirmatory of FVP. Testing for a PRKAG mutation was advised for her.

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右心室心尖起搏时心室-心房传导缺失，但准希氏起搏时出现结节反应 - 其机制是什么？

一名 13 岁女孩在站在火车上时出现了一次晕厥前兆。她的心电图显示为预激。超声心动图显示心脏结构正常，没有任何心室肥大。在电生理学检查中，即使使用异丙肾上腺素，她的心室-心房（VA）传导也不存在。然而，进行副希氏起搏操作（PHP）后，发现 VA 传导一致，并伴有结节反应。这一发现表明，基线时的 VA 解离是在髂下水平（VH），而 HA 传导完好无损。此外，这一发现还与导致她出现这种心电图模式的束状室性通路（FVP）的推测相一致。来自不同心房部位（右心房、冠状窦）的起搏显示出几乎固定的预激和短的无变化 HV 间期，证实了 FVP。建议对她进行 PRKAG 基因突变检测。

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来源期刊

Indian Pacing and Electrophysiology Journal Medicine-Cardiology and Cardiovascular Medicine

CiteScore

2.20

自引率

0.00%

发文量

审稿时长

61 days

期刊介绍： Indian Pacing and Electrophysiology Journal is a peer reviewed online journal devoted to cardiac pacing and electrophysiology. Editorial Advisory Board includes eminent personalities in the field of cardiac pacing and electrophysiology from Asia, Australia, Europe and North America.