Author + information
- Received June 5, 2019
- Revision received August 26, 2019
- Accepted August 29, 2019
- Published online November 18, 2019.
- Hussam Ali, MD∗ (, )
- Sara Foresti, MD,
- Pierpaolo Lupo, MD,
- Guido De Ambroggi, MD,
- Riccardo Mantovani, MD,
- Carmine De Lucia, MD,
- Ilaria Passarelli, MD and
- Riccardo Cappato, MD
- ↵∗Address for correspondence:
Dr. Hussam Ali, Arrhythmia and EP Research Center, IRCCS Humanitas Research and University Hospital, Via A. Manzoni 56, 20089 Rozzano, Milan, Italy.
• Para-Hisian pacing is a valuable maneuver to assess ventriculo-atrial conduction patterns.
• Its dynamic behavior at a unique anatomic site may produce various electrophysiological phenomena.
• It provides additional advantages compared with conventional ventricular pacing or intravenous adenosine.
• Accurate interpretation requires recognition of the captured structures, adequate atrial mapping, and His recordings.
More than 2 decades ago, para-Hisian pacing was introduced to assess the pattern of retrograde conduction during electrophysiological studies. Although there is no ideal maneuver for every patient and condition, para-Hisian pacing is a valuable and handy strategy to differentiate between retrograde conduction over the atrioventricular node and the accessory pathways. The dynamic behavior of para-Hisian pacing, in a region with unique anatomical features, can produce various activation patterns and intriguing electrophysiological phenomena. Although the demonstration of a retrograde nodal activation pattern during para-Hisian pacing does not rule out the presence of an accessory pathway, evidence of retrograde conduction over an accessory pathway does not prove its active role in the culprit tachycardia. Multipolar His bundle recordings, detailed atrial mapping, and recognition of the truly captured structures and the impact of temporal changes of autonomic tone or pacing rates, are essential keys for accurate interpretation of this maneuver that may ultimately guide judicious catheter ablation of the arrhythmic substrate. This review aims to summarize the practical usefulness and potential pitfalls of the para-Hisian pacing maneuver, focusing on the interpretation of electrocardiograms and intracardiac recordings.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received June 5, 2019.
- Revision received August 26, 2019.
- Accepted August 29, 2019.
- 2019 American College of Cardiology Foundation
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