Catheter-Induced Intra-Hisian and Intrafascicular Block During Recording of His Bundle Electrograms

Abstract

Mechanical injury of the atrioventricular (A-V) node, His bundle, and right bundle branch is a potential complication of His bundle recording. In the presence of left bundle branch block, catheter-induced injury of the right bundle branch may cause prolongation of A-V conduction time or even complete A-V block. Two cases are reported in which catheter-induced transient high grade Mobitz II A-V block, acute reversible prolongation of infranodal conduction time with probable intra-Hisian conduction delay, and persistent (6 hours duration) complete A-V block occurred in patients with left bundle branch block. The observations made indicate that A-V conduction times and the appearance of "split His" potentials may be influenced by the recording catheter itself, and suggest that the operators be prepared to institute immediate right ventricular pacing when His bundle recordings are obtained in patients with left bundle branch block.

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“…Similar problems may also occur during intracardiac electrophysiologic studies (Akhtar et al .. 1977;Jacobson and Scheinmann, 1974;Levites et al .. 1976). In addition, mechanical stimulation of the atria or ventricles may cause ectopic beats (Akhtar et al .. 1977).…”

Longterm remission of left posterior fascicular ventricular tachycardia due to mechanical trauma

“…This conduction block is ascribed to mechanical trauma and is referred to as "catheter-induced trauma". Catheter-induced trauma has been reported in the atrioventricular node 7,8 , the His bundle 9 , the right bundle branch 10 , the atrium 11 , and the accessory pathways 11,12 . Catheter-induced mechanical trauma incidence was reported in 2-14% of patients receiving radiofrequency ablation for supraventricular tachycardia 8,11,12 .…”

Catheter‐Induced Mechanical Trauma to Fast and Slow Pathways during Radiofrequency Ablation of Atrioventricular Nodal Reentry Tachycardia: Incidence, Predictors, and Clinical Implications

“…The occurrence of catheter‐induced trauma to accessory pathways and atrial and ventricular foci during RFA is well known 1–6 . However, data on the incidence and significance of catheter‐induced trauma to AV nodal pathways during AVNRT ablation are scarce.…”