Response to letter to editor titled “Para‐Hisian Pacing Maneuver: A Pitfall in the Pitfall”

Nair, Krishna Kumar Mohanan; Thajudeen, Anees; Namboodiri, Narayanan; Valaparambil, Ajitkumar

doi:10.1111/jce.13220

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2023

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“…It is important to understand certain limitations before concluding based on PHP. 5,8,[11][12][13][14][15][16][17][18][19][20][21][22][23][24] A common misconception about PHP is that it is useful only for septal APs. 25 However, even with left or right lateral APs, as long as pacing from the para-Hisian region conducts to the atrium with the RAA sequence being analyzed, this maneuver can be used to determine whether that activation is AV node-dependent or AP-dependent.…”

Section: Discussionmentioning

confidence: 99%

Paradoxical Para-Hisian Pacing Response

EFE,

MEROVCI,

CALAPKULU

et al. 2023

J Innov Cardiac Rhythm Manage.

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Para-Hisian pacing (PHP) is among the most useful maneuvers in cardiac electrophysiology during sinus rhythm and identifies whether retrograde conduction is dependent on the atrioventricular (AV) node. In this maneuver, the retrograde activation time and pattern are compared during capture and loss of capture of the His bundle while pacing from a para-Hisian position. A common misconception about PHP is that it is useful only for septal accessory pathways (APs). However, even with left or right lateral pathways, as long as pacing from the para-Hisian region conducts to the atrium with the activation sequence being analyzed, it can be used to determine whether that activation is AV node–dependent or AP-dependent.

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