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Related Experiment Videos

Wenckebach phenomenon within the atria.

N Kerin, H Schwartz

    Journal of Electrocardiology
    |January 1, 1975
    PubMed
    Summary

    Electrical pacing can reveal hidden intra-atrial conduction defects, leading to Wenckebach and Mobitz II blocks in patients with pre-existing bifascicular block. This highlights the importance of electrophysiological study in syncope evaluation.

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    Area of Science:

    • Cardiology
    • Electrophysiology
    • Cardiac Electrophysiology

    Background:

    • A patient presented with a history of fainting and a bifascicular block, specifically complete right bundle branch block (CRBBB) with left posterior hemiblock (LPH).
    • Conventional 12-lead electrocardiogram (ECG) showed a normal surface ECG, necessitating further investigation.

    Observation:

    • His bundle electrograms were utilized to analyze the patient's cardiac conduction system.
    • During atrial pacing, an intra-atrial conduction defect manifested as a Wenckebach block, affecting the atrium or the electrode-atrium junction.
    • The sinus intra-atrial conduction time (P-A interval) remained within normal limits under baseline conditions.

    Findings:

    • Atrial pacing at rates between 138-148 beats/min progressively lengthened the St-A interval, culminating in a second-degree Wenckebach block.
    • This induced intra-atrial conduction defect occurred only with electrical pacing, not on the baseline surface ECG.
    • Concurrently with the atrial Wenckebach block, a second-degree Mobitz II atrioventricular block developed.

    Implications:

    • Electrophysiological testing can uncover latent intra-atrial conduction abnormalities not evident on surface ECG.
    • The development of both atrial and atrioventricular block under pacing suggests complex conduction system disease.
    • These findings underscore the utility of His bundle electrograms in diagnosing the cause of syncope in patients with conduction abnormalities.

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