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Volume 36, Issue 1, Pages 73-79 (January 2003)


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Atypical atrioventricular Wenckebach periodicity caused by conduction through triple atrioventricular junctional pathway as a probable mechanism

Takakazu Katoh, MD*, Shinji Kinoshita, MD, Yoshinori Tsujimura, MD, Yoshihiko Sasaki, MT

Abstract 

Electrocardiograms were taken from an 84-year-old man with right bundle branch block in whom atypical atrioventricular Wenckebach periodicity was frequently occurred. The electrocardiographic findings as mentioned below suggested that the atypical periodicity was caused by conduction through triple atrioventricular junctional pathways as a probable mechanism. When a P wave was blocked after a markedly prolonged PR interval of 0.64 s, the RP interval containing this blocked P wave ranged between 0.84 s and 0.86 s, and the next P wave was followed by a QRS complex of the same configuration, with the PR interval of 0.35 s. On the other hand, when a P wave was blocked after a PR interval of 0.49 s or 0.52 s, the RP interval containing this blocked P wave was comparatively long, ie, 0.95 s or 0.98 s, and the next P wave was followed by a QRS complex of somewhat different configuration showing borderline left axis deviation, with a shorter PR interval of 0.21 s or 0.23 s. These findings suggest that longitudinal dissociation occurred not only in the atrioventricular junction but also in the His bundle. This is the first report suggesting triple atrioventricular junctional pathways probably associated with longitudinal dissociation in the His bundle.

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* Katoh Cardiovascular Clinic, Ohtsu

 Hokkaido Women's University, Ebetsu, Hokkaido

 Division of Cardiology

 Central Laboratory, Ohtsu Municipal Hospital, Ohtsu; Japan

 Reprint requests: Takakazu Katoh, MD, Katoh Cardiovascular Clinic, Taishogun 3-Chome 8-16, Ohtsu 520-2145, Japan.

PII: S0022-0736(02)30451-5

doi:10.1054/jelc.2003.036073


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