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Clinical and Electrophysiological Observations

Kenneth M. Rosen, MD; Ramesh C. Dhingra, MD; Henry S. Loeb, MD; S. H. Rahimtoola, MD, FRCP

Arch Intern Med. 1973;131(5):663-672.

Abstract
His-bundle (H) electrograms were recorded in 49 adults with chronic heart block. Heart failure was noted in five (29%) patients having block proximal to H, in seven (87%) with "split" H potentials, and in ten (42%) with block distal to H. Syncope occurred in five patients (29%) with block proximal to H, in two patients (25%) with "split" H potentials, and in 15 patients (63%) with block distal to H, in whom syncope was significantly more frequent (P<.05). Of the total group, QRS complexes were narrow in 16 and wide in 33.

Although symptoms related to bradycardia occurred in all groups, syncope was significantly more common with block distal to H. Neither ventricular rate or QRS duration could be used as an absolute guide to the site of block.

Author Affiliations
Chicago

From the Section of Cardiology, Department of Medicine, Abraham Lincoln School of Medicine, and the Department of Adult Cardiology, Cook County Hospital, University of Illinois College of Medicine, Chicago. Dr. Dhingra is presently with the West Side Veterans Administration Hospital, Chicago, Dr. Loeb is with the Edward Hines, Jr. Veterans Administration Hospital, Hines, Ill, and Dr. Rahimtoola is with the University of Oregon Medical School, Portland, Ore.

Footnotes
Received for publication Sept 7,1972; accepted Oct 17.

Reprint requests to Section of Cardiology, University of Illinois Hospital, Box 6998, Chicago 60680 (Dr. Rosen).

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