{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T22:22:55Z","timestamp":1773008575626,"version":"3.50.1"},"reference-count":2,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2023,8,31]],"date-time":"2023-08-31T00:00:00Z","timestamp":1693440000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pacing Clinical Electrophis"],"published-print":{"date-parts":[[2023,10]]},"abstract":"Abstract<\/jats:title>Introduction<\/jats:title>The management of patients with conduction disease and supraventricular arrhythmias presents a multitude of clinical challenges.Intra\u2010Hisian block, a condition characterized by delayed or blocked electrical conduction within the His bundle, can result in debilitating symptoms, such as syncope or presyncope. This case report aims to elucidate the diagnostic and therapeutic considerations that were taken in a patient who presented with recurrent syncopal episodes that corresponded to atrial flutter (AFL) and subsequently underwent cavotricuspid isthmus ablation.<\/jats:p><\/jats:sec>Case presentation<\/jats:title>A 65\u2010year\u2010old male with paroxysmal AFL and a pre\u2010existing right bundle branch block and left anterior fascicular block (RBBB+LAFB) experienced recurrent syncopal episodes that were found to be correlated with AFL episodes. Following CTI ablation, an electrophysiology study (EPS) revealed a prolonged HV interval of 101ms, which indicated potential conduction abnormalities. With coronary sinus pacing, an intra\u2010Hisian delay of 211ms was observed. During instances of atrioventricular block, intra\u2010Hisian delay was evident on conducted beats, followed by intra\u2010Hisian block on non\u2010conducted beats. Ultimately, the patient's syncopal episodes prompted the placement of a dual\u2010chamber pacemaker, which resulted in the resolution of symptoms.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>Intra\u2010Hisian block is a condition that is often associated with delayed or blocked electrical conduction within the His bundle. When symptomatic, patients often present with syncope or presyncope. Etiologies of this condition include degenerative changes, myocardial infarction, autoimmune disorders, infections, medications, and more. This case emphasizes the importance of electrophysiology studies (EPS) in the diagnosis and management of patients with intra\u2010Hisian block. Prompt intervention, such as the placement of a dual\u2010chamber pacemaker, can alleviate symptoms and improve patient outcomes. Thus, clinical awareness and utilization of EPS can aid in accurate diagnosis and appropriate treatment selection for patients with conduction abnormalities and supraventricular arrhythmias.cuspid isthmus (CTI) ablation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pace.14808","type":"journal-article","created":{"date-parts":[[2023,8,31]],"date-time":"2023-08-31T10:55:09Z","timestamp":1693479309000},"page":"1182-1185","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["An interesting case of infra\u2010hisian block"],"prefix":"10.1111","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3250-7768","authenticated-orcid":false,"given":"Harini","family":"Lakshman","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine Ascension Providence Hospital Southfield Michigan USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sukriti","family":"Banthiya","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Ascension Providence Hospital Southfield Michigan USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ammar","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Ascension Providence Hospital Southfield Michigan USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dipak","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Ascension Providence Hospital Southfield Michigan USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,8,31]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrcr.2015.06.015"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.2174\/1573403\u00d716666200511090151"}],"container-title":["Pacing and Clinical Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.14808","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,12]],"date-time":"2023-10-12T04:07:41Z","timestamp":1697083661000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pace.14808"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,31]]},"references-count":2,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2023,10]]}},"alternative-id":["10.1111\/pace.14808"],"URL":"https:\/\/doi.org\/10.1111\/pace.14808","archive":["Portico"],"relation":{},"ISSN":["0147-8389","1540-8159"],"issn-type":[{"value":"0147-8389","type":"print"},{"value":"1540-8159","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,31]]},"assertion":[{"value":"2023-03-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-08-15","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-08-31","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}