Weekly EP & ECG rounds at the BIDMC (Archive)
Editors-In-Chief: Chris Pickett,M.D.; Peter Zimetbaum, M.D.; Mark Josephson, M.D.
August 2007
This patient is a 53 year old woman with a history of SVT who is referred for an electrophysiology study due dyspnea with exertion and a Holter ECG which showed several episodes of AV block second degree with 5:4, 4:3, and 3:2 conduction, as well as brief episodes of a junctional rhythm during the daytime. Prior to her EP study, she underwent stress testing and exercised 4 minutes on a BRUCE protocol, during whch she developed AV Wenckebach block and the test was stopped. She never has had an episode of syncope.
This is the baseline ECG:
![](/images/f/f5/Baseline_ECG_RBBB_LAFP_long_PR.jpg)
Her baseline intracardiac recording shows:
![](/images/8/80/Infranodal_Wenkebach_case_baseline_Intracardiac_with_long_HV_copy.jpg)
This is her intracardiac recording with atrial pacing:
![](/images/3/3e/A_pacing_with_infranodal_Wenkebach_copy.jpg)