Concealed Nonparoxysmal Junctional Tachycardia

    loading  Checking for direct PDF access through Ovid

Abstract

SUMMARY

Electrophysiologic studies were performed in a patient who had an apparently uncomplicated complete trifascicular block. His bundle recordings revealed atrioventricular dissociation with: 1) an atrial rate of 58 beats/min, 2) an idioventricular escape rate of 45 beats/min, and 3) nonparoxysmal junctional tachyeardia (His bundle rhythm) at a rate of 65–85 beats/min. The latter arrhythmia was electrocardiographically silent, influencing neither atrial nor ventricular events. The arrhythmia probably reflected digitalis intoxication (digoxin level of 3.3 ng/ml). A repeat electrophysiologic study 4 days after digoxin was discontinued revealed complete trifascicular block (distal to H) with intact conduction between the atrium and the His bundle (AH of 150 msec). Thus, electrophysiologic study demonstrated an electrocardiographically silent but clinically relevant arrhythmia, suggesting that His bundle recording should be part of diagnostic study during temporary pacemaker implantation in patients with atrioventricular block

Related Topics

    loading  Loading Related Articles