Sustained atrioventricular conduction delay due to interpolated ventricular premature systole

doi:10.1016/0002-9149(65)90065-2

The American Journal of Cardiology

Volume 16, Issue 5, November 1965, Pages 765-766

https://doi.org/10.1016/0002-9149(65)90065-2 Get rights and content

Abstract

A case of marked and persistent P-R prolongation following an interpolated premature ventricular contraction is reported. The importance of the underlying physiologic mechanism and the differentiation of this mechanism from organic impairment of A-V conduction, A-V nodal rhythm with retrograde conduction or of A-V nodal rhythm with A-V dissociation is stressed.

References (1)

L.N. Katz et al.
Clinical Electrocardiography, the Arrhythmias
L.N. Katz et al.
Clinical Electrocardiography, the Arrhythmias

Cited by (3)

Interference dissociation in the presence of dual atrioventricular nodal physiology
2017, HeartRhythm Case Reports
Citation Excerpt :
Findings compatible with simultaneous conduction along 2 pathways in response to a ventricular premature complex were noted in our patient’s ECG (Figure 3), indicating presence of underlying dual AV nodal physiology. Dual AV nodal physiology can manifest itself as normal sinus rhythm, spontaneous shortening or lengthening of the PR interval persisting for varying periods of time, PR interval alternans,2–7 PR interval alternans with Wenckebach sequence of the slowly and rapidly conducting pathways, and conduction along both pathways in response to a single sinus impulse.8–12 In the presence of sinus rhythm the presenting ECG (Figure 1) and continuous rhythm strip (Figure 2) illustrate an unusual presentation masquerading as dual AV nodal physiology.
Electrocardiographic manifestations of dual atrioventricular node conduction during sinus rhythm
1997, Journal of the American College of Cardiology
Objectives. The objective of this study was to correlate electrocardiographic (ECG) PR interval changes during normal sinus rhythm with recent observations regarding the anatomy and physiology of the dual, slow and fast atrioventricular (AV) pathways.
Background. The least common manifestation of dual AV conduction is an abrupt PR interval change in the setting of sinus rhythm. Whereas isolated cases of this phenomenon have been reported, the relatively large series we have collected makes it possible to correlate the ECG findings with the anatomy, composition and electrophysiology of the dual AV pathways.
Methods. The ECGs of 21 patients with sinus rhythm and PR interval changes consistent with dual AV node physiology were studied. Observations include duration of the short and long PR intervals, the difference between the two and the events responsible for the PR interval change.
Results. Eighteen of the 21 ECGs exhibited an abrupt and persistent PR interval change. Two of the other three ECGs manifested PR interval alternans, with slow and fast pathway, and a Wenckebach type I AV block; in the third ECG, findings compatible with simultaneous conduction along both pathways in response to a single stimulus were noted. Events responsible for the PR change included atrial premature complexes, atrial tachycardia, interpolated ventricular premature complexes and interpolated junctional premature complexes. In two the PR interval change appeared during a regular sinus rhythm.
Conclusions. The behavior of the PR interval is consistent with dual AV conduction. The PR interval duration hypothesized to represent slow pathway conduction is in keeping with the calculated anatomic length of the slow pathway. The Wenckebach type I block in the slow and fast pathways, as well as the altered conduction time in the slow pathway parallel with changing sinus rate, is evidence that the pathway is influenced by autonomic (?parasympathetic) innervation, supporting the premise that the pathways contain AV node-like tissue.
(J Am Coll Cardiol 1997;29:1015–22)
© 1997 by the American College of Cardiology
Gene mutations resulting in the development of ARVC/D could affect cells of the cardiac conduction system
2012, Frontiers in Physiology

^☆: This study was supported by the Herman C. Krannert Fund, the Indiana Heart Association, Indiana State Board of Health and (in part) by the U. S. Public Health Service Training Grant 5363 and (in part) with facilities provided by the Cardiovascular Clinical Research Center Grant H-6308 from the National Heart Institute, National Institutes of Health, U. S. Public Health Service.

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Diagnostic shelfSustained atrioventricular conduction delay due to interpolated ventricular premature systole☆

Abstract

Clinical Electrocardiography, the Arrhythmias

Clinical Electrocardiography, the Arrhythmias

Diagnostic shelf
Sustained atrioventricular conduction delay due to interpolated ventricular premature systole☆