His bundle electrocardiography in digitalis-induced "atrioventricular junctional" Wenckebach periods with irregular H-H intervals

Am J Cardiol. 1979 Mar;43(3):653-6. doi: 10.1016/0002-9149(79)90027-4.

Abstract

His bundle electrograms were recorded during catheter insertion for prophylactic demand pacing in two patients with accelerated or nonaccelerated "atrioventricular (A-V) junctional" rhythms associated with A-V junctional Wenckebach periods. This appears to be the first published report of so-called A-V junctional Wenckebach periods in which the characteristic irregularities of the H-H intervals were recorded. Patient 1 had an additional area of "complete" anterograde A-V nodal (A-H) block. In Patient 2 the rate of impulse formation was consistent with nonparoxysmal A-V junctional tachycardia. The His bundle recordings were obtained in patients with digitalis toxicity and should be interpreted in the context. The integration of clinical and intracardiac findings with extrapolations from microelectrode and pharmacolic studies and with deductions from the clinical electrocardiograms suggests that the conduction disturbances probably occurred within the A-V node itself (in its AN region). This hypothesis implies that automaticity also originated in the A-V node because the site of impulse formation must have been proximal to the site of the Wenckebach periods. However, conclusive proof of of these postulates will require further studies with refined techniques.

Publication types

  • Case Reports

MeSH terms

  • Bundle of His / drug effects
  • Bundle of His / physiopathology*
  • Cardiac Pacing, Artificial
  • Digitalis Glycosides / adverse effects
  • Digitalis Glycosides / pharmacology
  • Electrocardiography*
  • Heart Block / chemically induced
  • Heart Block / diagnosis*
  • Heart Block / physiopathology
  • Heart Conduction System / physiopathology*
  • Humans

Substances

  • Digitalis Glycosides