Jogger’s Wenckebach

Report:

Sinus rhythm

Wenckebach (Möbitz 1) second degree AV block, atypical

Periods of 2:1 conduction (block)

Comment:

The patient may well have a mild form congenital heart block, but the progressive angina should call for evaluation of his coronary reserve. Angiography would be the best starting point at present. An exercise test should demonstrate improved conduction in uncomplicated congenital AV block and may, of course, indicate ischæmia.

In an ordinary jogger, “athlete’s heart” as the cause of AV block remains unlikely.

In both strips, the P waves are distorted by the overlying (?underlying) T waves. Below, in Fig 37a, (note a different lead, probably aVR), the three P waves before the first pause are almost completely disguised and one may think there are three junctional beats following a blocked P wave. That P wave is not blocked, but its (and subsequent) PR intervals are much longer than expected. Either a very atypical Wenckebach or an example of dual conduction. Confusingly, superimposition of P and T waves is called fusion in Wagner’s unfortunate rendering of Marriott’s famous book.27