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A Premature Ventricular Complex as Both Culprit and Cure: Paroxysmal Intrinsic Atrioventricular Block
Rakesh Agarwal1, Dimitrios Lypourlis1
1Department of Cardiology, Lyell McEwin Hospital, Adelaide, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia.
Background:
Paroxysmal atrioventricular block (AVB) due to phase 4 depolarization of the His-Purkinje system is an uncommon but clinically important cause of syncope and ventricular asystole.
Case Summary:
We report a case in which a premature ventricular complex (PVC) initiated infra-Hisian AVB, resulting in prolonged ventricular asystole despite ongoing sinus activity. Notably, recovery of atrioventricular conduction was triggered by a subsequent PVC.
Discussion:
This case provides a clear mechanistic illustration of pause-dependent conduction failure and recovery in diseased His-Purkinje tissue. Recognition of this pattern is critical, as it reflects advanced conduction system disease and mandates permanent pacing.
Take-Home Message:
PVC-initiated, and terminated, paroxysmal phase 4 AVB is a marker of advanced His-Purkinje disease and differentiates intrinsic phase 4 AVB from vagally mediated AVB and sinus arrest.
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