His bundle in electrocardiographic semantics of AV block. Anatomoclinical considerations

Abstract

The AV conducting system was examined histologically in 13 selected human hearts (7 control and 6 AV block specimens), focusing attention upon normal His bundle (HB) structure, and upon the histopathologic basis of intrahisian block, with supraventricular QRS configuration. HB revealed a poor morphologic identity, often failing to represent the "undivided stem" of the AV pathway, either due to an early partition into separate longitudinal fascicles, or to varied types and sites of bifurcation, without any definite boundary between nonbranching and branching portions. Split His potentials, the distal component of which has been suggested as arising in the proximal bundle branch system, has been found in a case free of HB histologic abnormality. Supraventricular QRS configuration in escape rhythm was observed in two cases of AV block, not withstanding destruction of the entire His bifurcation, and in experimental bilateral bundle branch block. Pertinent explanations have been suggested. The overall semantic value and usefulness of the current HB nomenclature do not seem to imply, as yet, a precise and constant anatomoclinical correlation.