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Gepubliceerd in: Netherlands Heart Journal 12/2020

Open Access 31-07-2020 | Rhythm Puzzle – Answer

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Auteurs: L. Baris, E. J. van den Bos

Gepubliceerd in: Netherlands Heart Journal | Uitgave 12/2020

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Answer

The phenomenon of grouped beating is present, in which the QRS complexes occur in groups of two beats and the cycle length between the groups is less than twice the RR interval within the groups. The second beat of each group is preceded by a P wave, with a very long PR interval of 680 msec, whereas the first beat comprises a junctional escape (Fig. 1). This could be mistaken for a sinus bradycardia with first-degree atrioventricular (AV) block and premature junctional depolarisations in bigeminy. However, the extreme PR interval makes it more plausible that one of these P waves is blocked at the level of the AV node.
Thus, the diagnosis is a second-degree 2:1 AV block with an extremely long PR interval in a healthy young man due to increased vagal tone. The very long PR interval could be exaggerated due to increased refractoriness of the AV node caused by retrograde conduction of the junctional escape beat or due to slow pathway conduction in dual AV nodal physiology, or a combination of the two.
Vagally mediated AV block frequently occurs because of a vagal surge and is generally a benign physiological phenomenon in healthy young individuals [1].

Conflict of interest

L. Baris and E.J. van den Bos declare that they have no competing interests.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://​creativecommons.​org/​licenses/​by/​4.​0/​.
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Literatuur
1.
go back to reference Alboni P, Holz A, Brignole M. Vagally mediated atrioventricular block: pathophysiology and diagnosis. Heart. 2013;99:904–8. CrossRef Alboni P, Holz A, Brignole M. Vagally mediated atrioventricular block: pathophysiology and diagnosis. Heart. 2013;99:904–8. CrossRef
Metagegevens
Titel
Shop till you drop
Auteurs
L. Baris
E. J. van den Bos
Publicatiedatum
31-07-2020
Uitgeverij
Bohn Stafleu van Loghum
Gepubliceerd in
Netherlands Heart Journal / Uitgave 12/2020
Print ISSN: 1568-5888
Elektronisch ISSN: 1876-6250
DOI
https://doi.org/10.1007/s12471-020-01479-x