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Two-to-one AV block associated with the congenital long QT syndrome
E Pruvot1, A De Torrente, G M De Ferrari
1Division of Cardiology, University Hospital, Lausanne, Switzerland. etienne.pruvot@hospvd.ch
Introduction:
Conduction abnormalities associated with long QT syndrome (LQTS) have been reported as "pseudo 2:1 AV block" due to sinus intervals shorter than ventricular refractoriness.
Method And Results:
We report the electrophysiologic characteristics of a patient suffering from congenital LQTS with episodes of true 2:1 AV block. Induction of 2:1 infra-Hisian blocks and return to 1:1 conduction were observed using single atrial and ventricular extrastimuli. The block was located in the Purkinje network but not in the myocardium.
Conclusion:
The His-Purkinje system of our LQTS patient displayed dynamic properties with a strong increase in refractoriness for short-long sequences and a decrease for long-short sequences that triggered intermittent 2:1 AV blocks.