Unusual form of AV nodal Wenckebach block.
A 73-year-old man had a fast atrioventricular (AV) nodal pathway accidentally ablated 4 years before, while attempting to ablate a septally located concealed accessory pathway (AP). After initiation of treatment with beta-blockers, because of systemic arterial hypertension, the patient presented to the emergency room complaining of a markedly diminished exercise tolerance. The 12 lead ECG showed an interesting AV nodal Wenckebach sequence, interrupted by P waves retrogradely conducted through the AP. The mechanisms explaining the ECG are discussed.
Rivero-Ayerza
M
M
Cardiovascular Research and Teaching Institute Aalst, Aalst, Belgium.
Kalpakos
D
D
De Zutter
M
M
Geelen
P
P
Brugada
P
P
D000368:Aged; D004562:Electrocardiography; D006327:Heart Block / Q000503:physiopathology*; D006801:Humans; D008297:Male; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000503:physiopathology*