His bundle electrography

What is His bundle electrography?

His bundle electrography (HBE) is a highly specialized type of cardiac electrophysiology study (EPS) used to evaluate electrical conduction through the bundle of His—the region of the heart that connects the right and left chambers of the heart and triggers a heartbeat. This procedure provides detailed information about the bundle of His and is used to diagnose and treat abnormal heart rhythms.

Why is His bundle electrography done?

The primary purpose of HBE is to diagnose and treat abnormal rhythms from the top part of the heart, known as supraventricular tachycardia (SVT). SVT can cause an unusually fast or irregular heartbeat and can be very uncomfortable. It can also increase the risk of heart failure or stroke. HBE helps doctors to accurately diagnose and examine the bundle of His, and provides detailed information about how the heart's electrical signals travel through it. This information can then be used to create an individualized treatment plan for a person's SVT.

Preparing for a His bundle electrography

Before a HBE is performed, a person should let their doctor know about any medications they are taking, including over-the-counter drugs, herbal supplements, and prescription medications. They should also tell their doctor about their health history and any allergies they may have. The person will also need to fast for 8–12 hours before the procedure.


The doctor will carry out the HBE in a hospital or clinic. They start by cleaning and numbing the person's skin at the site where they will insert the EPS catheters. Next, the doctor will use X-ray or ultrasound imaging guidance to carefully feed the catheters through the patient's body and into the heart. The catheters have electrodes on the tips that enable the doctors to measure the electrical activity of the heart. Thecatheter is then advanced through the vein and into the vena cava. It will then be further advanced into the tricuspid valve and the His bundle region. Once in position, the doctor will monitor and record the electrical conduction of the heart and use this information to diagnose the person's condition and develop a personalizedBtreatment plan.

Types of His bundle electrography

There are two types of His bundle electrophysiology studies, transvenous and endocardial. The transvenous approach is most widely used. It involves inserting a catheter into a vein in the leg and advancing it into the right atrium of the heart. The endocardial approach involves a doctor directly accessing the heart tissue through a hole in the chest or a small incision in the neck.


HBE is a safe procedure, but there are some associated risks, including infection at the insertion site, bruising from the insertion, and the risks associated with X-ray-guided procedures. Also, if the HBE is used to treat an abnormal rhythm, it can cause some temporary symptoms, such as shortness of breath or chest pain.

When to consider His bundle electrography

HBE is usually used after other diagnostic tests, such as an ECG, have failed to provide a clear diagnosis of the person's condition. It is also recommended if a person experiences unexplained chest pain, palpitations, or a sensation of lightheadedness or dizziness. HBE is also recommended if a person has recurrent episodes of sudden, rapid heartbeats or has a family history of unexplained cardiac arrest or sudden death.