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SHORT COMMUNICATION
Year : 2021  |  Volume : 11  |  Issue : 4  |  Page : 211

Retrograde his activation and resetting of the sinus node in parahisian pathway


Department of Cardiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

Date of Submission13-May-2021
Date of Acceptance21-May-2021
Date of Web Publication25-Oct-2021

Correspondence Address:
Dr. Debasis Acharya
Department of Cardiology, All India Institute of Medical Sciences, Bhubaneswar - 751 019, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jicc.jicc_27_21

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How to cite this article:
Acharya D, Das D, Das T, Pramanik S. Retrograde his activation and resetting of the sinus node in parahisian pathway. J Indian coll cardiol 2021;11:211

How to cite this URL:
Acharya D, Das D, Das T, Pramanik S. Retrograde his activation and resetting of the sinus node in parahisian pathway. J Indian coll cardiol [serial online] 2021 [cited 2021 Dec 5];11:211. Available from: https://www.joicc.org/text.asp?2021/11/4/211/329156



A 25-year-old male with structurally normal heart and frequent palpitation was admitted for electrophysiology study. Electrocardiography showed groups of 3 beats followed by a pause and initiation of a narrow complex regular tachycardia. First beat was narrow, second beat was wide, third beat was again a narrow complex with prolonged PR interval and it was followed by a noncompensatory pause [Figure 1].
Figure 1: Pattern of group beating followed by initiation of narrow complex tachycardia

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Electrophysiology study revealed the initial beat to be a sinus complex with AH interval of 79 msec. The middle one was a preexcited beat with negative HV interval [Figure 2]. This preexcited ventricular complex was retrogradely activating the His and this retrograde His activation rendered the His relatively refractory so that the next sinus beat (third beat) was conducted to the ventricle with prolonged AH interval (concealed conduction).[1] Interestingly, the third beat was also producing an echo beat which was resetting the sinus node resulting in a noncompensatory pause.[2] EP study revealed parahisian pathway which was successfully ablated from the noncoronary cusp. Our case is a beautiful demonstration of retrograde His activation and resetting of the sinus node in parahisian pathway with intermittent preexcitation.
Figure 2: Retrograde His activation with concealed conduction, echo beat and noncompensatory pause

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Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Lehmann MH, Mahmud R, Denker S, Soni J, Akhtar M. Retrograde concealed conduction in the atrioventricular node: Differential manifestations related to level of intranodal penetration. Circulation 1984;70:392-401.  Back to cited text no. 1
    
2.
Dhingra RC, Wyndham C, Amat-Y-Leon, Denes P, Wu D, Rosen KM. Sinus nodal responses to atrial extrastimuli in patients without apparent sinus node disease. Am J Cardiol 1975;36:445-52.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2]



 

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