Alternating reversed wenckebach periodicity: Concealed electrotonic conduction as a possible mechanism☆

Electrocardiograms were taken from a 67-year-old man with 2:1 atrioventricular block in whom alternating reversed Wenckebach periodicity was found. Long PR intervals of alternately conducted P waves progressively shortened until an alternate P wave was blocked. After an alternate P wave was blocked, the next alternate P wave was conducted to the ventricles with a markedly long PR interval. Then long PR intervals of alternately conducted P waves progressively shortened again until an alternate P wave was blocked. This is the first report on alternating reversed Wenckebach periodicity. It seems that concealed electrotonic conduction of alternately blocked impulses occurred as a possible mechanism.