His-Purkinje system longitudinal dissociation: From bench to bedside. A case of output-dependent fascicular capture.
INTRODUCTION
Histological studies reported that the His bundle (HB) is partitioned into narrow cords by collagen running in its long axis, providing the anatomical setting necessary for its longitudinal dissociation. Further confirmations came from the demonstration that direct HB pacing normalizes the QRS axis and duration in subjects with proximal HB lesions causing bundle branch block. However, there is no evidence of the possibility of selective HB partitions pacing destined to the composition of branches and fascicles.


METHODS AND RESULTS
We describe a case of intra-Hisian left bundle branch block in which permanent distal HB pacing corrects left ventricular delay and produces different QRS morphology at different voltage outputs, as an expression of different selective HB compartments recruitment.


CONCLUSION
This case would strengthen the limited data in the literature about HB longitudinal dissociation.
['Marinaccio|Leonardo|L|0000-0002-7480-2861', 'Vetta|Francesco|F|', 'Ignatiuk|Barbara|B|0000-0001-6089-6644', 'Giacopelli|Daniele|D|0000-0003-1584-7944', 'Patrassi|Luigia A|LA|', 'Marchese|Domenico|D|']
D001145:Arrhythmias, Cardiac D002036:Bundle of His D002037:Bundle-Branch Block D002304:Cardiac Pacing, Artificial D004562:Electrocardiography D006801:Humans
His-Purkinje system bundle branch block His bundle longitudinal dissociation His bundle pacing cardiac resynchronization therapy