التفاصيل البيبلوغرافية
| العنوان: |
Atypical Wenckebach AV Block in the Infra-Hisian Region: Clinical Implications and Management. |
| المؤلفون: |
Kaushik, Atul1, Jeewooth, Avinash2 avinashjeewooth@ymail.com, Jaswal, Aparna2, Chakravarty, Amitesh2, Bashir, Hamed2, Raina, Sukriti2 |
| المصدر: |
American Journal of Case Reports. 12/20/2024, Vol. 25, p1-5. 5p. |
| مصطلحات موضوعية: |
*HIS bundle, *HEART block, *HEART diseases, *ARRHYTHMIA, *SYNCOPE |
| مستخلص: |
Background: Second-degree atrioventricular (AV) block is a frequently encountered conduction abnormality on surface electrocardiogram (ECG). However, it does not always imply a block at the AV nodal level. In rare cases, this block can occur below the bundle of His, within the infra-Hisian region of the His-Purkinje system. While the incidence of infra-Hisian block is generally low in the general population, it becomes more common in specific high-risk groups, such as older adults and individuals with structural heart disease. Infra-Hisian block carries a significant risk of progressing to complete heart block, particularly if the patient shows a markedly prolonged His-ventricular (HV) interval or evidence of a bi-fascicular block. Case Report: We present the case of a 65-year-old woman who experienced recurrent episodes of syncope. Her surface ECG revealed a bi-fascicular block along with Wenckebach AV block, and 24-h Holter monitoring showed no other significant abnormalities. A baseline short PR interval with second-degree AV block indicated a possible infranodal block. An electrophysiology study confirmed an atypical Wenckebach AV block with second-degree infra-Hisian AV block. The patient subsequently underwent permanent pacemaker implantation. Conclusions: Given its potential to develop into more severe forms of heart block, infra-Hisian block is a critical condition that requires accurate identification and management. Several ECG indicators can help diagnose second-degree AV block. For example, RP-dependent PR interval or RP-PR reciprocity is characteristic of Wenckebach AV block. A short PR interval at baseline and minimal amount of PR interval lengthening before block in type 1 second-degree AV block suggest involvement of the His-Purkinje system. [ABSTRACT FROM AUTHOR] |
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