Frequent His-Purkinje discharges with longitudinal dissociation in a case with multiple premature ventricular contractions suppressed by co-treatment with verapamil and quinidine.

His and proximal left bundle (LB) electrogram recordings revealed that His or LB potential always preceded multiple premature ventricular contractions (PVCs). Some ectopic LB discharges showed exit block inside the proximal LB. This appears to implicate pathological His-Purkinje tissue with longitudinal dissociation. Co-treatment with verapamil 240 mg/day and quinidine 300 mg/day could suppress PVCs and eliminate symptoms. Genetic analysis revealed a rare variant in LMNA in this patient.