The Journal of Thoracic and Cardiovascular Surgery, Vol 74, 28-36, Copyright © 1977 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
His bundle electrograms in 51 patients requiring permanent transvenous pacemakers
L Gould, CV Reddy, GC Brevetti, F Cifarelli, P Maghazeh and CS Shin
Fifty-one patients required the implantation of a Cordis Omnis-Stanicor
permanent pacemaker. His bundle electrograms studies, which included right
atrial pacing and sinoatrial (SA) node postsuppression recovery times, were
performed prior to the implantations. Pacing and sensing thresholds were
obtained in all patients. Syncope or episodes of dizziness were the
presenting symptoms in virtually every patient. Twenty-eight of the 51
patients had the sick sinus syndrome. Only nine patients were in complete
heart block, and an additional nine were in second-degree heart block. The
His bundle electrogram technique was not particularly helpful in selecting
the potential pacemaker candidate. The symptomatic patient with second- or
third-degree heart block requires a pacemaker. In the sick sinus syndrome,
the His bundle electrogram was a disappointing tool in detecting
abnormalities. In chronic bundle branch block, the His bundle electrogram
appears to play a major role. A prolonged H-V interval in a symptomatic
patient, in whom a specific noncardiac cause cannot be identified,
signifies that a pacemaker is required.
