In this review, we emphasize the unique value of recording the activation sequence of the His bundle or right bundle branch (RB) for diagnoses of various supraventricular and fascicular tachycardias. A close analysis of the His to RB (H-RB) activation sequence can help differentiate various forms of supraventricular tachycardias, namely atrioventricular nodal reentry tachycardia from concealed nodofascicular tachycardia, a common clinical dilemma. Furthermore, bundle branch reentry tachycardia and fascicular tachycardias often are included in the differential diagnosis of supraventricular tachycardia with aberrancy, and the use of this technique can help the operator make the distinction between supraventricular tachycardias and these other forms of ventricular tachycardias using the His-Purkinje system. We show that this technique is enhanced by the use of multipolar catheters placed to span the proximal His to RB position to record the activation sequence between proximal His potential to the distal RB potential. This allows the operator to fully analyze the activation sequence in sinus rhythm as compared to that during tachycardia and may help target ablation of these arrhythmias. We argue that 3 patterns of H-RB activation are commonly identified—the anterograde H-RB pattern, the retrograde H-RB (right bundle to His bundle) pattern, and the chevron H-RB pattern (simultaneous proximal His and proximal RB activation)—and specific arrhythmias tend to be associated with specific H-RB activation sequences. We show that being able to record and categorize this H-RB relationship can be instrumental to the operator, along with standard pacing maneuvers, to make an arrhythmia diagnosis in complex tachycardia circuits. We highlight the importance of H-RB activation patterns in these complex tachycardias by means of case illustrations from our groups as well as from prior reports.

中文翻译：

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His 或 Right 束的激活序列对诊断复杂心动过速回路的重要性

在这篇综述中，我们强调记录希氏束或右束支 (RB) 的激活序列对于诊断各种室上性和束状心动过速的独特价值。仔细分析 His 到 RB (H-RB) 激活序列可以帮助区分各种形式的室上性心动过速，即房室结折返性心动过速和隐匿性结束性心动过速，这是一种常见的临床困境。此外，束支折返性心动过速和束支性心动过速常被纳入室上性心动过速的异常鉴别诊断中，使用该技术可以帮助操作者区分室上性心动过速和其他类型的室性心动过速，使用 His-Purkinje系统。我们表明，通过使用多极导管放置以跨越近端 His 到 RB 位置来记录近端 His 电位到远端 RB 电位之间的激活序列，该技术得到了增强。与心动过速期间相比，这允许操作员全面分析窦性心律中的激活序列，并可能有助于对这些心律失常进行靶向消融。我们认为通常确定 3 种 H-RB 激活模式——顺行 H-RB 模式、逆行 H-RB（右束到希氏束）模式和 V 形 H-RB 模式（同时近端 His 和近端 RB 激活） )——并且特定的心律失常往往与特定的 H-RB 激活序列相关。我们表明，能够记录和分类这种 H-RB 关系对操作员很有帮助，连同标准的起搏动作，在复杂的心动过速回路中进行心律失常诊断。我们通过来自我们小组的案例说明以及之前的报告强调了 H-RB 激活模式在这些复杂的心动过速中的重要性。