This case report demonstrates that concealed reentry, rather than concealed antegrade conduction, can be the mechanism underlying atrioventricular nodal alternating Wenckebach periodicity.
May explain select atypical AV nodal conduction; leaves open prevalence and generalizability beyond this case.
Alternating WEnckebach periodicity is generally believed to reflect bilevel block due to horizontal electrophysiologic dissociation in the conducting tissues. We describe a case of atrial pacing-induced atrioventricular nodal alternating Wenckebach periodicity with concealed reentry in a longitudinally dissociated AV conduction system. Three observations support this unique mechanism: Concealed reentry occurred during the course of alternating Wenckebach periodicity; it could be invoked to explain the peculiar conduction patterns in this patient; and alternative mechanisms did not explain the alternating Wenckebach periods. Our findings also indicate that long conduction times during 2:1 block can be due to concealed reentry rather than concealed antegrade conduction, and participation in the echo process of a retrograde pathway with electrophysiologic characteristics of an atrioventricular nodal bypass tract does not exclude manifest and concealed reentry at a subatrial level.
No takes yet. Share an insight, caveat, or question.
Littmann et al. (1982) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: