This case report suggests that supernormal conduction may be the mechanism of the gap phenomenon in patients with exercise-induced atrioventricular block.
Supports supernormal conduction hypothesis in exercise-induced AV block; leaves open prospective validation before clinical adoption.
A 54-year-old man with normal atrioventricular (AV) conduction at rest gave a 4-year history of presyncope during exercise. Treadmill testing showed exercise induced AV block. Electrophysiological study demonstrated rate dependent infranodal AV block and abnormal refractory period of the His-Purkinje system. The gap phenomenon in AV conduction occurred during the programmed stimulation. Supernormal conduction could be considered as the mechanism of the gap phenomenon in this patient.
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Toeda et al. (2000) studied this question.
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