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Europace Advance Access published online on August 22, 2009
Europace, doi:10.1093/europace/eup232
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

SHORT COMMUNICATION

Paradoxical increase of stimulus to atrium interval despite His-bundle capture during para-Hisian pacing

Jurren M. van Opstal* and Harry J.G.M. Crijns

Department of Cardiology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands

Para-Hisian pacing at high output simultaneously captures the His bundle or proximal right bundle, as well as the adjacent ventricular myocardium. At lower output, direct His-bundle, or right-bundle, capture is lost which causes an increase in the stimulus to atrium interval. We describe a case with an increment of 68 ms with capture of the His bundle. This seems to be a paradoxical response, which however can be explained by the presence of retrograde dual AV-node physiology. Continuation of this phenomenon could be related to concealed anterograde invasion of the fast pathway thereby maintaining the retrograde activation during para-Hisian pacing on the slow pathway despite paced cycle lengths (His to His intervals) where retrograde fast pathway conduction proved to be possible.

* Corresponding author. Tel: +31 433875093, Email: jmvanopstal{at}yahoo.com

Manuscript submitted 26 June 2009. Accepted after revision 29 July 2009.


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