Sustained Concealed Conduction on Holter Monitor

Report:

Sinus rhythm 60 – 70/min

Borderline first degree AV block

Second degree AV block, Wenckebach (Möbitz 1) type

VEB, interpolated

Concealed retrograde conduction in three subsequent cycles

Comment:

Sustained PR interval prolongation after an intercalated VEB is uncommon. Both lesser and greater degrees of it are shown elsewhere in this Library. It does not, per se, have any special significance. In appearance it is the reverse of AV Wenckebach conduction.

Nether does a single dropped P wave at 3 am in the upper panel; the main risk here is that the patient may be subjected to EPS or even pacing, or told she has a “heart block” without explaining its innocence. It could even have been a pseudoblock, caused by a concealed extrasystole.

The palpitations were due to VEBs, at times frequent or bigeminal (below). Their overall density during the study was 3,392 out of 108,386 beats. Again, it would be better to persuade the patient not to have any therapy for those. Paul Wood said, somewhere: if there is no evidence of heart disease, VEBs are not it.