Progression of intrahisian atrioventricular block: Will this presage a renaissance of His-bundle studies?

Abstract

In this issue of HeartRhythm is a very interesting article by Ragupathi et al, 1 Ragupathi L. Johnson D. Greenspon A. Frisch D. Ho R.T. Pavri B.B. Clinical and electrophysiological characteristics of patients with paroxysmal intra-His block with narrow QRS complexes. Heart Rhythm. 2018; 15: 1372-1377 Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar who describe the natural history of patients with putative intrahisian atrioventricular (AV) block. The authors have nicely shown that although these patients often present with traumatic and very worrisome syncopal episodes, they seem to have a very low incidence of progression to complete AV block. There are 2 major clinical extrapolations of these observations. First, the low incidence of right ventricular pacing would seem to obviate the risk for development of cardiac failure as a result of asynchronous right ventricular pacing; hence, consideration for biventricular pacing seems not to be an issue. Second, in the rare instances when progression occurs, these patients would be excellent candidates for His-bundle pacing. Clinical and electrophysiological characteristics of patients with paroxysmal intra-His block with narrow QRS complexesHeart RhythmVol. 15Issue 9PreviewAtrioventricular (AV) block is usually due to infranodal disease and associated with a wide QRS complex; such patients often progress to complete AV block and pacemaker dependency. Uncommonly, infranodal AV block can occur within the His bundle with a narrow QRS complex. Full-Text PDF