Is fluoroscopy necessary for pacemaker insertions and his bundle studies?

We report a patient with atrioventricular reentrant tachycardia (AVRT) with bidirectional conduction over an anteroseptal accessory pathway (AP) who underwent successful ablation in the non-coronary aortic sinus (AS). In three previous attempts, the intracardiac recordings showed an anteroseptal AP with antegrade and retrograde conduction that failed to be ablated in spite of radiofrequency (RF) applications from the right and left anteroseptal regions. During the study, the earliest atrial activation during tachycardia was recorded in the non-coronary AS preceding the atrial activation at the His bundle (HB) region by 24 ms, and the anteroseptal AP was successfully blocked by one single ablation in the non-coronary AS. These data strongly suggest that careful mapping of an anteroseptal AP in the non-coronary AS may provide an alternative ablation approach in patients with previously failed ablation.

Bundle of His↗

PubMed2006

Wenckebach-phenomenon at the left bundle branch.

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Bundle of His↗

PubMed2006

Wilhelm His Jr. (1863-1934)--the man behind the bundle.

Wilhelm His Jr. (1863-1934) was a Swiss-born cardiologist and anatomist. In 1893, he discovered the bundle of His-the specialized tissue in the heart that transmits the electrical impulses and helps synchronize contraction. He pioneered studies in cardiac conduction and coined the term "heart block," which he identified as the cause of Adams-Stokes disease. He was a professor of medicine at the University of Berlin, became the dean of medicine in 1918 and in 1928 was elected rector of the University of Berlin. Through his long clinical and teaching career he became better known for his work on gout and diseases of the joints. "Trench fever," or Werner-His disease, was also named after him. This report presents the life and work of Wilhelm His Jr., who was described by his colleagues as "a master of his profession, a great physician, investigator, and a well cultured gentleman."

Bundle of His↗