Wenckebach AV Block in Acute Inferior Infarction
Report:
Sinus rhythm 90/min
Möbitz 1 (Wenckebach) second degree AV block
Intraventricular conduction defect (IVCD)
QRS 0.12â
Acute inferior infarction
Comment:
The most striking feature are the marked precordial reciprocal changes, indicating extensive infarction.
The IVCD escapes easy definition despite RSRâ pattern in V1, where the secondary (Râ) R wave is too narrow and is not associated with S waves in 1 or V6. The latter leads suggest incomplete LBBB, but this is excluded by the presence of normal septal q waves there. The term periinfarctional block is attractive, but is (rightly) no longer used.
A week later (52a) there is considerable voltage loss, but the diagnostic Q waves have not developed in the inferior leads. R wave loss is their equivalent. The AV block persists, although increments in PR interval have become invisible. The mysterious escape beats terminating the pauses are in fact pacemaker-sinus fusion beats, with the (bipolar) pacing spikes too small to see. This is clearer overpage, without fusion Fig 52b).
52a. Inferior and general voltage loss is equivalent to Q waves.
52b. Pacemaker escape beats are easier to recognise.
53. 67 year old man with chest pain.
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