Classical Wenckebach Trigeminy
Report:
Sinus rhythm 98/min
Second degree AV block, Möbitz 1, with 4:3 conduction
Trigeminy
Left atrial abnormality (LAA)
Left bundle branch block
Atypical repolarisation pattern suggests ischæmia
Comment:
The patient had low-therapeutic digoxin level 1.0 nmol/L (range 1.0 â 2.6 nmol/L); the drug was stopped âjust in caseâ. He had two previous infarctions and LV ejection fraction of 37%, mitral incompetence and dilated left atrium; there were 90% lesions in all three major vessels. He was refused surgery and died few days later.
The Wenckebach sequences show the classical pattern of decreasing R-R and increasing (but decrementally) P-R intervals.
A 1:1 conduction with PR interval 0.30â is shown below (Fig 152a).
Fig 152a. Latent AV block in 1:1 conduction.
Fig 153. 79 year old man with calcified mitral annulus and incompetence requiring mitral valve replacement four days previously.
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