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A demonstration of differential refractoriness within a single fascicle of the human ventricular specialized conduction system.

Abstract：

:In 15 patients with left bundle branch block (LBBB), atrial (A), His bundle (H), and ventricular (V) electrograms were recorded. Successively more premature atrial depolarizations were introduced via a catheter in the right antrium. In eight patients, the ventricular specialized conducting system (VSCS) was the most refractory portion of the entire atrioventricular conducting system (AVCS) and A-V conduction, which had been occurring via the right bundle branch (RBB), failed below the His bundle as the effective refractory period (ERP) of the VSCS was reached. In two of these eight patients, after the ERP of the VSCS was exceeded, further shortening of the H1-H2 interval (by 40 to 50 msec.) resulted in an unexpected resumption of A-V conduction, but with markedly prolonged H-V intervals (160 to 230 msec.). This demonstrates that differential refractoriness exists within the RBB of these patients. A zone of maximal refractoriness was initially encountered within the RBB when the premature impulse first blocked below the His bundle. In relative terms, this zone was distal to a more proximal area of the RBB where, with further shortening of the H1-H2 interval, sufficient conduction delay occurred to permit recovery of excitability distally and the resumption of A-V conduction.

journal_name

Am Heart J

journal_title

American heart journal

authors

Cannom DS,Goldreyer BN,Damato AN

doi

10.1016/0002-8703(75)90194-5

subject

Has Abstract

pub_date

1975-06-01 00:00:00

pages

779-84

issue

6

eissn

0002-8703

issn

1097-6744

pii

0002-8703(75)90194-5

journal_volume

89

pub_type

杂志文章

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