Limitation of the atrial extrastimulus technique for assessment of the His-Purkinje system in patients with right bundle branch block
Wyse, D.G.; Szeto, P.M.; Bond, R.
Clinical and Investigative Medicine. Medecine Clinique et Experimentale 6(4): 275-279
1983
ISSN/ISBN: 0147-958X PMID: 6671357 Document Number: 197259
A prospective study of the usefulness of the atrial extrastimulus technique for assessment of the His-Purkinje system was undertaken in 19 consecutive patients with complete RBBB and an abnormal or indeterminate frontal QRS axis. A total of 59 basic cycle lengths (BCLs) could be analyzed in detail. The most common patterns of His-Purkinje conduction seen were simple linear (V1V2 vs H1H2, N = 49) or flat (H2V2 vs H1H2, N = 44) curves. This finding is related to the limitation imposed by interposition of the slowly conducting AV node between the site of the extrastimulus and the His-Purkinje system. One or more refractory periods could be measured in only 27% of BCLs (10 Effective Refractory Periods of the remaining intact His-Purkinje system plus 16 Functional Refractory Periods and 19 Relative Refractory Periods). No refractory periods of the His-Purkinje system could be determined in 8 of 19 patients (42%), the major limitation being slowed AV node conduction. The results suggest limited likelihood that additional clinically useful information about His-Purkinje system conduction can be obtained by the atrial extrastimulus technique, as used in this study, although it may be helpful in assessing other parts of the conduction system.