Abstract
Six pediatric patients (pts) exhibiting atrial pacing-induced repetitive block (B) are presented. Analysis of the conduction patterns satisfy the requisites for multilevel AV B. 1) DOCUMENTED 2 LEVEL B: Two pts exhibited an upper level AVN Wenckebach periodicity (WP) and a lower level 2:1 infra-His B. 2) DEDUCED 2 LEVEL B IN THE AVN: Two pts had 2:1 AVN B terminated by 3:1 B (alternating WP). With group 1 serving as a model, it is postulated that in this group the 2 sites of B are within the AVN: an upper level AVN WP and a lower level 2:1 AVN B. One pt had an AVN WP terminated by 3:1 B. This was followed by 2 series of 2:1 B, suggesting simultaneous WP at 2 AVN levels. 3) DEDUCED 3 LEVEL B IN THE AVN: One pt had 2:1 AVN B with progressive prolongation of the conducted AH terminating in 2 series of 3:1 B in which the AH following the 1st 2 blocked atrial beats was not the shortest while that following the 2nd was. With previous groups serving as models, it is postulated that there is a 3 level B inside the AVN: an upper level AVN WP, a middle level AVN WP of higher degree B and a lower level 2:1 AVN B. In summary, we have for the first time, described multilevel B within the AVN in the pediatric pt.
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Young, ML., Gelband, H. & Wolff, G. 162 ALTERNATING WENCKEBACH PERIODICITY AND MULTILEVEL AV BLOCK. Pediatr Res 19, 137 (1985). https://doi.org/10.1203/00006450-198504000-00192
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DOI: https://doi.org/10.1203/00006450-198504000-00192