Localization of site of traumatic heart block with his bundle recordings

摘要: Abstract A patient is described with complete heart block and a ventricular septal defect, both secondary to stab wound of the chest. The escape rhythm was characterized by wide QRS interval configuration suggesting right bundle branch block. His (H) recordings revealed “split” H potentials P-H1 100 msec an H2-V 40 msec. Recording left (LB) showed spike occur in H2-LB 15 LB-V 25 Atrial pacing produced prolongation P-H1, administration atropine isoproterenol shortening. Wenckebach periods proximal H1 were noted at atrial paced rate 190/min. During study, pattern unexpectedly shifted from block, H2 still preceding each interval. most likely explanation for this occurrence longitudinal dissociation distal allowing preferential distribution cardiac impulse one or other ventricle. However, possibility varying shifting pacemaker branches could not be absolutely excluded. In summary, recording suggested site bundle. Observations are made on nature evidence presented.