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KMID : 1011920210220010007
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International Journal of Arrhythmia
2021 Volume.22 No. 1 p.7 ~ p.7
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A case of infra-nodal Wenckebach conduction block with alternating bundle branch block
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Khmao Pichmanil
Hwang Chun
Pak Hui-Nam
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Abstract
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Background: Atrioventricular (AV) node normally has decremental conduction property and a longer refractory period than His-Purkinje system (HPS). This results in AV conduction delay or block at the level of AV node in response to short-coupled atrial premature beats. Prolonged refractoriness in HPS can produce unusual physiological patterns of AV conduction such as conduction delay or infra-nodal block in the distal elements of HPS.
Case presentation: We present a case in which atrial premature stimulation produces infra-nodal Wenckebach conduction block which initiates long-short cycle sequence within the bundle branches resulted in alternating bundle branch block and atypical pattern of Ashman phenomenon.
Conclusions: This case highlights the importance of recognizing the unusual physiological AV conduction patterns of HPS. The long-short cycle sequence in the bundle branches of distal HPS and linking phenomenon can result in alternating bundle branch block without the presence of HPS disease.
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KEYWORD
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Ashman phenomenon, Atrioventricular node, Bundle branch block, His-Purkinje system, Infra-nodal block
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