Jaco Fishenfeld

Non-paroxysmal A-V junctional tachycardia associated with acute myocardial infarction

Abstract The hospital records of 48 subjects with acute myocardial infarction complicated by non-paroxysmal A-V junctional tachycardia (NPJT) were reviewed. Fifteen of 48 subjects (31 per cent) so affected died. NPJT was most commonly associated with inferior wall infarction ( 24 48 , 50 per cent). Although ten of 16 (63 per cent) patients with acute anterior wall infarction and NPJT died, 23 of 24 patients with acute inferior wall myocardial infarction survived. Mean heart rates during NPJT were significantly greater in subjects with anterior wall infarction (113.4 ± 35.3 vs. inferior wall 85.4 ± 28.1, P

Heart block during cardiac catheterization— Demonstration by his bundle recording and documentation of concealed retrograde A-V nodal conduction*

Summary Utilizing His bundle electrography, catheter induced complete heart block was documented distal to the main His bundle in two subjects with pre-existent bundle branch block. In the first patient, concealed retrograde A-V nodal conduction was manifested by unexpected failure of atrial depolarizations to result in His deflections. The second subject demonstrated a similar phenomenon, but altered A deflection polarity and fluoroscopic monitoring indicated probable “pseudo concealed retrograde A-V nodal conduction” secondary to recording catheter movement. This report represents the first description of 1) catheter induced complete heart block with simultaneous concealed retrograde A-V nodal conduction and 2) His bundle electrographic demonstration of complete heart block secondary to catheter induced trauma of the left bundle branch in a subject with complete right bundle branch block.

Similar QRS complexes on the surface electrocardiogram during intact atrioventricular conduction and atrioventricular dissociation with documented idioventricular rhythm

His bundle electrography was performed in three patients with bilateral bundle branch block who manifested similar QRS complexes during atrioventricular (A-V) dissociation and intact A-V conduction. In two such patients ventricular depolarizations (V) were not preceded by His bundle potentials (H) at regular H-V intervals, suggesting a ventricular origin for the subsidiary pacemaker. In the third patient, H preceded V at shortened H-V intervals, indicating a proximal bundle branch rhythm with retrograde His bundle depolarization. It is concluded that the presence of similar QRS complexes during A-V conduction and A-V dissociation does not always indicate an A-V junctional origin of the subsidiary pacemaker. Under these conditions, His bundle electrography is a useful method for determining the site of lower impulse formation.