This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by AKHTAR, M. Articles by VARGAS, G. Search for Related Content PubMed PubMed Citation Articles by AKHTAR, M. Articles by VARGAS, G.

(Circulation. 1974;50:1150.)
© 1974 American Heart Association, Inc.

---

Demonstration of Re-entry within the His-Purkinje System in Man

MASOOD AKHTAR M.D.¹; ANTHONY N. DAMATO M.D.¹; WILLIAM P. BATSFORD M.D.¹; JEREMY N. RUSKIN M.D.¹; J. BIMBOLA OGUNKELU M.D.¹; GUILLERMO VARGAS M.D.¹

¹ From the Cardiopulmonary Laboratory, U.S. Public Health Service Hospital, Staten Island, New York.

Re-entry within the His-Purkinje system (HPS) was consistently observed in 15/24 consecutive patients in whom retrograde refractory period studies were performed using His bundle electrograms and the ventricular extrastimulus method. Within a narrow range of ventricular coupling intervals (V₁V₂), V₂ retrogradely conducted to the bundle of His (H₂) with significant infra-His bundle conduction delay (V₂H₂ interval). At critical V₂H₂ delays another beat of ventricular origin (V₃) followed V₂ and was associated with H₂V₃ intervals greater than the H-V intervals of sinus beat. It is postulated that V₂ retrogradely blocked within the right bundle branch and activated the bundle of His via the left bundle branch after which antegrade conduction occurred along the right bundle branch producing the V₃ response. In support of re-entry within the HPS are the following: 1) V₃ occurred in a narrow range of V₁V₂ intervals and critical V₂H₂ delays, 2) V₃ did not occur when V₂ retrogradely blocked below the bundle of His, 3) V₃ was independent of retrograde A-V nodal delay, 4) V₃ rarely occurred in patients with pre-existing complete right bundle branch block pattern. These results reasonably exclude local re-entry near the site of stimulation.

Key Words: Refractory periods • Retrograde conduction

Submitted on April 1, 1974
Accepted on July 22, 1974

This article has been cited by other articles:

				M. R. Boyett \#8216;And the beat goes on' The cardiac conduction system: the wiring system of the heart Exp Physiol, October 1, 2009; 94(10): 1035 - 1049. [Abstract] [Full Text] [PDF]

				H. Guo, S. Hecker, S. Levy, and B. Olshansky Ventricular tachycardia with QRS configuration similar to that in sinus rhythm and a myocardial origin: differential diagnosis with bundle branch reentry Europace, January 1, 2001; 3(2): 115 - 123. [Abstract] [PDF]

				J. L. Merino, J. R. Carmona, I. Fernandez-Lozano, R. Peinado, N. Basterra, and J. A. Sobrino Mechanisms of Sustained Ventricular Tachycardia in Myotonic Dystrophy : Implications for Catheter Ablation Circulation, August 11, 1998; 98(6): 541 - 546. [Abstract] [Full Text] [PDF]

				S. M. Pogwizd Nonreentrant Mechanisms Underlying Spontaneous Ventricular Arrhythmias in a Model of Nonischemic Heart Failure in Rabbits Circulation, August 15, 1995; 92(4): 1034 - 1048. [Abstract] [Full Text]

				A. B. Wagshal, L. A. Pires, and S. K. Stephen Management of Cardiac Arrhythmias With Radiofrequency Catheter Ablation Arch Intern Med, January 23, 1995; 155(2): 137 - 147. [Abstract] [PDF]