Comment to 'Congestive heart failure or conduction failure?'
Comment to Congestive heart failure or conduction failure?

  • Thanks Fathi and Mansour. Great points. Amyloidosis is a consideration and I think it is under diagnosed in daily clinical practice. MRI would be valuable here.

    this patient had a pacemaker implant due to symptomatic first degree AV block. because of frequent RV pacing I decided to implant His bundle Pacemaker, patient symptoms Significantly improved after pacemaker implant I will share with you old EKGS and also EKG post ppm implant.

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      Thanks Yousef  Questions/comments:

      1.Although His pacing makes physiological sense, however, it is cumbersome and can be tedious. Do we have data to support superiority over RV pacing for this patient with preserved EF?

      2.The pacing EKG does not look "pure"  HBP. The QRS is wider than baseline EKG and there is a significant axis shirt (from right at baseline to extreme left on paced EKG), how to explain that? do you think it is capturing some other fascicular elements instead, with or without some RV? a post implant CXR will be very helpful if you have it.

      3.What is HBP threshold?

      Great case!

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    ScrubdIn

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