Interpolated VEBs in Advanced AV Block

Report:

Sinus tachycardia 108/min

Second degree, advanced (4:1, 3:1) AV block

VEBs, multiform, interpolated

Left bundle branch block

Comment:

The ætiology of the block remained unknown; it could have been due to polyarteritis nodosa through its associated hypertensive heart disease.

No effect on the conducted PR intervals, and no wonder! The interpolation recorded in lead 2 is a rare example of a VEBs not increasing the degree of established AV block. This is due to the great length of the conducted ventricular cycles.

Ideally, PR intervals should be compared in the same lead – and lead 2 has no ectopic-free cycles. In this imperfect world, other leads have to be used. I think all the conducted PR intervals are of equal length. In Germany, 50mm/sec traces are taken routinely, for precise measurements. It’s not worth the extra paper.

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