Multiple gap phenomena associated with dual His bundle pathways having a lower common tract

Abstract

We report a case showing 4 types of aberrant conduction and 2 types of gap phenomena produced by single atrial extrastimulus during sinus rhythm. One of the gap phenomena was associated with dual His bundle pathways, demonstrating a fast-to-slow jump-up phenomenon. Of note, a sharp potential considered as retrograde His bundle activations was recorded, which indicated that the activation wave front descended the slow His bundle pathway and turned up the fast His bundle pathway.