Reverse Wenckebach Phenomenon After Surgical Repair of Bicuspid Aortic Valve

The Wenckebach phenomenon of atrioventricular conduction is deemed a physiological response of the atrioventricular node to a high atrial rate. However, the reverse Wenckebach phenomenon is under-recognized. We report an instance of reverse Wenckebach phenomenon developing into complete heart block in a 33-year-old man who experienced syncope after surgical repair of prolapsed bicuspid aortic valves. His condition was managed by temporary pacing. However, long-term follow-up demonstrated that the reverse Wenckebach phenomenon and severe heart block was reversible, avoiding the need for a permanent pacemaker. Reverse Wenckebach phenomenon can occur spontaneously and degenerate to complete heart block. Combined with our findings, early recognition and prompt intervention may save the patient at risk. The reverse Wenckebach phenomenon paradoxically indicates an atrioventricular block at the intra-Hisian or infra-Hisian level, heralding a more severe atrioventricular block in the near future. This phenomenon after valve surgery may be temporary.