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Apparent AV junctional escape in Wenckebach AV block: markedly slow conduction through the slow AV pathway

Kinoshita, Shinji; Katoh, Takakazu; Hagisawa, Kohsuke; Fukushima, Tsutomu; Ikawa, Shinji

Journal of Cardiovascular Medicine: February 2009 - Volume 10 - Issue 2 - p 161–166
doi: 10.2459/JCM.0b013e32831a6a0d
Case reports
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We report here two cases of Wenckebach atrioventricular (AV) block in which apparent AV junctional escape was observed, but most likely resulted from markedly slow conduction through the slow pathway of dual AV junctional pathways. In these cases, it seems that a blocked P-wave was followed by an AV junctional escape beat. However, a blocked P-wave occasionally failed to be followed by an escape beat, and the RR interval containing the blocked P-wave was markedly longer than the above escape interval. In one case, apparent AV junctional escape beats with aberrant ventricular conduction were found, and QRS complexes of the same configuration were also found without the preceding ventricular pause. This strengthens the possibility that apparent AV junctional escape occurred because of markedly slow conduction through the slow AV pathway.

aHokkaido University, Sapporo, Japan

bKatoh Cardiovascular Clinic, Ohtsu, Japan

cSapporo Hospital, Self-Defense Force, Sapporo, Japan

Received 21 February, 2008

Revised 25 May, 2008

Accepted 23 September, 2008

Correspondence to Shinji Kinoshita, MD, Tonden 4-Jo 3-Chome 3-27, Kita-Ku, Sapporo 002-0854, Japan Fax: +81 11 771 0366; e-mail: kinoshita-s@mri.biglobe.ne.jp

© 2009 Italian Federation of Cardiology. All rights reserved.