Long Latency
Report:
Sinus rhythm
Latent (first degree) AV block
PR 0.90”
Left anterior hemiblock
Right bundle branch block
Old anterior infarction
Comment:
This is the longest sustained first degree AV block I have seen. It is possible that the rhythm is other than sinus - the P waves are rather small - or that the sinus impulses are not conducted, being merely ‘linked’ to a prevailing junctional or idioventricular rhythm. They could also, conceivably, be retrograde upright91 P waves. Finally, initial portion of the P waves may be masked by the terminal portion of the T waves.
It is known that the rhythm was not idioventricular, since atrial pacing produced the same QRS morphology later (strip below), but at a spike-QRS interval less than half as long. At other times the patient was in AF; the striking original ECG is, unfortunately, the only record of the 0.90” PR interval.
The longest PR interval reported is 1.10”!92
If you have any suggestions for or feedback on this report, please let us know.
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