Author + information
- Received December 18, 2019
- Revision received May 16, 2020
- Accepted June 1, 2020
- Published online August 26, 2020.
- Aleksandr Voskoboinik, MBBS, PhDa,
- Edward P. Gerstenfeld, MDa,
- Joshua D. Moss, MDa,
- Henry Hsia, MDa,
- Jeffrey Goldberger, MDb,
- Babak Nazer, MDc,
- Thomas Dewland, MDc,
- David Singh, MDd,
- Nitish Badhwar, MDe,
- Patrick J. Tchou, MDf,
- John N. Meriwether, MDg,
- William Sauer, MDg,
- Asaf Danon, MDh,
- Bernard Belhassen, MDi and
- Melvin M. Scheinman, MDa,∗ ()
- aDivision of Cardiology, University of California San Francisco, San Francisco, California
- bDivision of Cardiology, University of Miami, Miami, Florida
- cKnight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
- dDivision of Cardiology, The Queen’s Medical Center, Honolulu, Hawaii
- eDivision of Cardiology, Stanford University, Stanford, California
- fDivision of Cardiac Electrophysiology, Cleveland Clinic, Cleveland, Ohio
- gCardiac Arrhythmia Service, Brigham and Women’s Hospital, Boston, Massachusetts
- hDepartment of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
- iHeart Institute, Hadassah University Hospital, Jerusalem, Israel
- ↵∗Address for correspondence:
Dr Melvin M. Scheinman, Department of Cardiac Electrophysiology, University of California San Francisco, 400 Parnassus Avenue, Fifth Floor, San Francisco, California 94143.
Background By virtue of its unique anatomy and ion channel composition, the His-Purkinje system (HPS) is prone to a variety of arrhythmic perturbations.
Objectives This study sought to characterize the presentations, electrophysiological features and diagnostic maneuvers for a series of unique arrhythmias involving the HPS.
Methods The authors present a collaborative multicenter case series of 6 patients with HPS-related arrhythmias. All patients underwent electrophysiological studies using standard multipolar catheters.
Results In 3 patients, both typical and reverse bundle branch re-entry were seen, with 1 patient demonstrating “figure of 8” re-entry likely involving the septal fascicle. One patient presented with systolic dysfunction associated with a high premature ventricular complex burden, with the mechanism being bundle-to-bundle re-entrant beats masquerading as dual response to a single sinus impulse. Two patients were diagnosed with interfascicular re-entry. Diagnosis was aided by careful assessment of HV interval in sinus rhythm and ventricular tachycardia, multipolar catheters to assess the activation sequence of the His-right bundle branch, and fascicles and entrainment of different components of the HPS. Cure of the arrhythmia was achieved by ablation of the right bundle branch block in 3 patients, the left septal fascicle in 2 patients, and the left posterior fascicle in 1 patient.
Conclusions Proper diagnosis of re-entrant arrhythmias involving the HPS may prove challenging. We emphasize a structured approach for diagnosis and effective therapy.
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 December 18, 2019.
- Revision received May 16, 2020.
- Accepted June 1, 2020.
- 2020 American College of Cardiology Foundation
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