A case report of paroxysmal complete atrioventricular block in a patient with dextrocardia and repaired tetralogy of Fallot

Figures

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  Figure 1. An implantable loop recorder (confirm rx™) recorded a bradycardia event. The patient was in complete atrioventricular block for 60 seconds.

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  Figure 2. (A) Twelve-lead electrocardiogram showing sinus rhythm and three bundle blocks (first-degree atrioventricular block, complete right bundle branch block, and left anterior hemiblock) (B) chest X-ray showing dextrocardia.

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  Figure 3. Record from the implantable loop recorder showing the complete atrioventricular block, which is a 5.5 times magnification of Figure 1. ▼: onset of the pause with third-degree atrioventricular block. ▼: regular P waves during the pause.

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  Figure 4. (A) Fluoroscopic images of electrophysiology catheters position in situs inversus and dextrocardia (right anterior oblique view). (B) Electrophysiological study showing first-degree His-ventricular block (heart rate, 67 bpm; atrio-His interval, 105 milliseconds; His-ventricular interval, 66 milliseconds). The maximum sinus node recovery time was 1220 milliseconds, and the Wenckebach rate was 140 ppm. Ventricular tachycardia was not induced by extra single, double, triple, or burst pacing at the right ventricular outflow and apex. RA, right apex; RV, right ventricle.

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  Figure 5. A dual chamber pacemaker was implanted with the A-lead in the right atrial appendage and the V-lead in the right ventricular apex.