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Case Reports
. 2024 Aug 6;12(22):5276-5282.
doi: 10.12998/wjcc.v12.i22.5276.

Selective his bundle pacing eliminates crochetage sign: A case report

Yan-Guang Mu  1 , Ke-Sen Liu  2
Affiliations
Case Reports

Selective his bundle pacing eliminates crochetage sign: A case report

Yan-Guang Mu et al. World J Clin Cases. .

Abstract

Background: Crochetage sign is a specific electrocardiographic manifestation of ostium secundum atrial septal defects (ASDs), which is associated with the severity of the left-to-right shunt. Herein, we reported a case of selective his bundle pacing (S-HBP) that eliminated crochetage sign in a patient with ostium secundum ASD.

Case summary: A 77-year-old man was admitted with a 2-year history of chest tightness and shortness of breath. Transthoracic echocardiography revealed an ostium secundum ASD. Twelve-lead electrocardiogram revealed atrial fibrillation with a prolonged relative risk interval, incomplete right bundle branch block, and crochetage sign. The patient was diagnosed with an ostium secundum ASD, atrial fibrillation with a second-degree atrioventricular block, and heart failure. The patient was treated with selective his bundle pacemaker implantation. After the procedure, crochetage sign disappeared during his bundle pacing on the electrocardiogram.

Conclusion: S-HBP eliminated crochetage sign on electrocardiogram. Crochetage sign may be a manifestation of a conduction system disorder.

Keywords: Atrial septal defect; Case report; Crochetage sign; Pacemaker; Selective his bundle pacing.

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Conflict of interest statement

Conflict-of-interest statement: All the authors declare that they have no conflict of interest to disclose.

Figures

Figure 1
Figure 1
Initial electrocardiogram. A: Atrial fibrillation with a long relative risk interval; B: Atrial fibrillation with crochetage pattern in leads II, III, and aVF and incomplete right bundle branch block (arrows pointing toward crochetage sign are most common).
Figure 2
Figure 2
Echocardiographic image. Echocardiography shows a secundum atrial septal defect that measured 2.32 cm.
Figure 3
Figure 3
Fluoroscopic image. The fluoroscopic image shows that the 3830 lead was located in the His-bundle region. A: Right-anterior-oblique 30° view; B: Left-anterior-oblique 40° view.
Figure 4
Figure 4
Postoperative electrocardiogram. Electrocardiogram showing the disappearance of crochetage sign after his-bundle pacing.
See this image and copyright information in PMC

References

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