Authors
Sudipta Mondal, Nadeem Afroz Muslim, Tapan Kr Matia, Debargha Dhua
Published in
The Journal of innovations in cardiac rhythm management. Volume 17. Issue 6. Pages 6777-6783. Epub Jun 15, 2026.
Abstract
A frail nonagenarian presented with incessant wide complex tachycardia exhibiting a left bundle branch block (LBBB) morphology. The arrhythmia was transiently responsive to adenosine boluses but proved refractory to direct-current cardioversion, exhibiting a pattern of immediate reinitiation. Upon transient termination, the baseline electrocardiogram demonstrated sinus rhythm with varying degrees of LBBB aberrancy. Intracardiac electrogram analysis was used to narrow the differential diagnosis of the tachycardia mechanism. Crucially, post-termination recordings documented a rare phenomenon of alternating bundle conduction during bradycardia. This was characterized by a severely diseased infra-Hisian conduction system with an H-V interval of 306 ms-representing one of the longest documented intervals in the literature. This case highlights the capacity for extremely slow, albeit tenuous, conduction within a profoundly diseased conduction system.
PMID:
42405018
Bibliographic data and abstract were imported from PubMed on 06 Jul 2026.
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