Key result
Observation avoids pacemaker implantation for paroxysmal AV block driven by intra-atrial reentrant tachycardia.
Case Report (n=1)
Paroxysmal AV block can occur solely during atrial tachyarrhythmia, and pacemaker implantation may be avoided if the underlying tachycardia is treatable or transient.
Paroxysmal AV block may occur selectively during IART post-ablation; leaves open whether targeted HPS evaluation changes management in similar cases.
Paroxysmal atrio-ventricular (AV) block is a relatively rare form of bradyarrhythmia that may be caused by vagal reflex, intrinsic His-Prukinje system (HPS) disorder, or idiopathic mechanisms. We report a case with paroxysmal AV block and syncopal episodes that appeared only during intra-atrial reentrant tachycardia (IART) after an ablation procedure. Syncope did not occur under sinus rhythm with stable 1:1 AV conduction. An HPS disorder was proven in an electrophysiological study. It was suggested that paroxysmal AV block was induced via a tachycardia-dependent mechanism with an exacerbation of latent HPS disorder. The occurrence of the IART was only transient, and there was no recurrent syncope during one-year follow-up. Pacemaker implantation could be avoided. < Learning objective: Paroxysmal atrio-ventricular block is a relatively rare form of bradyarrhythmia and can occur only during atrial tachyarrhythmia. Indications for a cardiac implantable electrical device should be carefully considered if the attributed tachycardia is treatable.>
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Honda et al. (2021) conducted a case report in Paroxysmal atrioventricular block and intra-atrial reentrant tachycardia (n=1). Intra-atrial reentrant tachycardia (IART) was evaluated on Occurrence of syncope and AV block. Paroxysmal AV block and syncope occurred only during intra-atrial reentrant tachycardia due to a latent His-Purkinje system disorder, avoiding the need for pacemaker implantation over 1 year.
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