Progression of Wenckebach type A-V block to high degree A-V block in aged man

This case report describes a 60 years old male with Wenckebach A-V block which progressed to high degree A-V block. Syncope and dizzy attacks were attributed to high degree A-V block in the study of ambulatory ECG (Holter). Wenckebach point was low; 90 bpm when the right atrium was paced. At 140 bpm, 2:1 A-H block with intermittent alternating and high degree A-H block were induced. Furthermore, a very wide His potential was recorded during the electrophysiological study. He received a permanent pacemaking. Since Wenckebach type A-V block is usually regarded as benign, this case seems to be rare.