Electrophysiologic Delineation of the Intraventricular

Two patients who had an endocardial cushion type of ventricular septal defect underwent electrophysiologic studies for detection of specialized conduction tissue during operative repair. In one patient, with an inferior leftward frontal plane QRS axis on the ECG, we recorded an intraventricular His bundle electrogram anterior and superior to the ventricular septal defect. In the other patient, with a mean QRS axis perpendicular to the frontal plane and a normal PR interval, we obtained intraventricular His bundle electrograms from both the anterosuperior and posteroinferior margins of the defect, suggesting dual atrioventricular conduction tracts (branching intraventricular His bundle). These anatomic and electrophysiologic findings may account for the more normally oriented QRS frontal plane axis on the surface ECG of both of these patients and support the hypothesis that the changes observed on the ECGs of patients with the various forms of endocardial cushion defect can be explained by alterations in the anatomic configuration of the specialized atrioventricular conduction tissue.