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Case Reports
. 2025 Mar 20;11(6):551-554.
doi: 10.1016/j.hrcr.2025.03.015. eCollection 2025 Jun.

Specific reaction to para-Hisian pacing in the presence of a concealed nodoventricular pathway

Soichiro Yamashita  1 , Makoto Takemoto  1 , Masamichi Iwasaki  1 , Masanori Okuda  1
Affiliations
Case Reports

Specific reaction to para-Hisian pacing in the presence of a concealed nodoventricular pathway

Soichiro Yamashita et al. HeartRhythm Case Rep. .
No abstract available

Keywords: Accessory pathway; Atrioventricular nodal reentrant tachycardia; Concealed nodoventricular pathway; Mahaim fiber; Para-Hisian pacing.

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Conflict of interest statement

The authors have no conflicts of interest.

Figures

Figure 1
Figure 1
12-lead electrocardiogram: Normal sinus rhythm (A) and tachycardia (B).
Figure 2
Figure 2
A: Extra pacing at 500/320 ms from the atrium. SVT was induced, showing an A-H-A pattern with infra-Hisian block. B: PVC from the RV apex at the His-refractory period during SVT. PVC reset the next atrial potential with delay, and SVT terminated with the HA block pattern. The third QRS complex is the fusion beat of SVT and PVC, excluding the nodofascicular pathway. PVC = premature ventricular contraction; RV = right ventricle; SVT = supraventricular tachycardia
Figure 3
Figure 3
Responses to PHPs in 2 different locations. A: Because of the difference in pacing output, the first and second beats showed wide and narrow QRS, respectively. The different HA intervals, regardless of the identical VA intervals, indicate that HB is not contained in the pathway from stimulation to the atrium, indicating the AP pattern. B: PHP at the ventricular side showed a different response. Although the first narrower beat resulted in a VA of 112 ms, the second wider beat resulted in a prolonged VA interval, indicating an AVN pattern. The lower schemes represent the presumed mechanism of the different responses. At site A, a normal AP pattern of PHP was observed because the pacing site was close enough to the NVP to conduct through the NVP. At site B, conduction through the HB is faster than conduction through the NVP because of the separation of the NVP and the pacing site. AP = accessory pathway; AVN = atrioventricular node; HB = His bundle; NVP = nodoventricular pathway; PHP = para-Hisian pacing; SP = slow pathway.
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References

    1. Ho R.T., Ortman M., Levi S.A. The various manifestations of concealed nodofascicular/nodoventricular bypass tracts. Heart Rhythm. 2020;17:1280–1290. - PubMed
    1. Nagashima K., Kaneko Y., Maruyama M., et al. Novel diagnostic observations of nodoventricular/nodofascicular pathway-related orthodromic reciprocating tachycardia differentiating from atrioventricular nodal ee-entrant tachycardia. JACC Clin Electrophysiol. 2020;6:1797–1807. - PubMed
    1. Sekihara T., Nakano T., Yasuoka Y., Minamiguchi H. A case of typical and atypical atrioventricular nodal reentrant tachycardia with a bystander nodoventricular pathway diagnosed based on the findings during early ventricular premature contractions. HeartRhythm Case Rep. 2020;6:680–684. - PMC - PubMed
    1. Nagashima K., Maruyama M., Kaneko Y., et al. Systematic observation-based diagnosis of atrioventricular nodal reentrant tachycardia with a bystander concealed nodoventricular pathway. J Arrhythm. 2024;40:131–142. - PMC - PubMed
    1. Hirao K., Otomo K., Wang X., et al. Para-Hisian pacing. a new method for differentiating retrograde conduction over an accessory AV pathway from conduction over the AV node. Circulation. 1996;94:1027–1035. - PubMed

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