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Marked 1st Degree Atrioventricular Block in Asymptomatic Male Runner

Image 2 of 2 in Series "Incomplete Congenital Atrioventricular Block in an Otherwise Healthy Male Runner"

Description

Sinus bradycardia at 52 bpm with marked, preserved PR prolongation of 420 ms and narrow QRS complexes without ST changes. This rhythm 1st degree atrioventricular block persisted throughout exercise treadmill testing and upon electrophysiology review raised concern for an incomplete congenital atrioventricular block with potential to progress and need permanent pacemaker insertion in the future.

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This image is part of the series "Incomplete Congenital Atrioventricular Block in an Otherwise Healthy Male Runner"

Other images in this series

Atypical Mobitz I [Wenckebach] Like 2nd Degree Atrioventricular Block in Asymptomatic Male Runner

by: Matthew T. Brown, MD

Atypical Second Degree Atrioventricular Block with basal rate of 39 bpm and increasing PR interval in beats 2 through 4 from 240 ms to 360 ms to 440 ms before a dropped beat. PR prolongation with R-R preservation is stereotypical of Wenckebach arrhythmia. In this EKG, it is important to note that while the R-R is relatively preserved at 39 bpm [~ 8 large boxes] a change is seen between beats 3 and 4 where the interval changes to 50 bpm [~6 large boxes]. This raises concern for a more atypical rhythm, possibly of sinus node dysfunction/sino-atrial block with junctional escape prompting further work-up. Additional findings include U-waves seen following each T wave and reassuring narrow QRS complexes without ST changes.