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Europace 2003 5(3):231-233; doi:10.1016/S1099-5129(03)00036-9
© 2003 by European Society of Cardiology
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ISSUE CARDIOGRAM

Unusual form of AV nodal Wenckebach block

M. Rivero-Ayerza, D. Kalpakos, M. De Zutter, P. Geelen and P. Brugada

Cardiovascular Research and Teaching Institute Aalst Aalst, Belgium

Abstract

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.

Key Words: Fast pathway ablation, AV block, Wenckebach block, concealed accessory pathway

Correspondence: Pedro Brugada, Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium. Fax: +32-53-72-4185; E-mail: pedro.brugada{at}pi.be


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