Intermittent atrioventricular block: procainamide administration as a provocative test

Twelve patients with clinical features suggesting possible intermittent high degree atrioventricular block were studied. All 12 patients had basic 1:1 atrioventricular conduction but nine had an electrocardiographic pattern of bifascicular distal conduction disease (right bundle branch block with left anterior or posterior hemiblock, or left bundle branch block). Intracardiac conduction was assessed by recording of the His bundle electrocardiogram and atrial pacing techniques, before and 20 minutes after intravenous administration of procainamide, in a dose of up to 10 mg/kg. Before procainamide administration, seven of the 12 patients had a prolonged H-V interval (greater than 55 ms). Procainamide administration lengthened the H-V interval in all 12 patients by 5--40 ms. In five patients, procainamide induced second or third degree AV block below the level of the bundle of His. It was concluded that the administration of procainamide may be a useful provocative test of distal conduction in patients with possible intermittent AV block.