Jun 1, 1982

Concealed reentry: a mechanism of atrioventricular nodal alternating Wenckebach periodicity

L Littmann, R H Svenson


Alternating WEnckebach periodicity is generally believed to reflect bilevel block due to horizontal electrophysiologic dissociation in the conducting tissues. We describe a case of atrial pacing-induced atrioventricular nodal alternating Wenckebach periodicity with concealed reentry in a longitudinally dissociated AV conduction system. Three observations support this unique mechanism: Concealed reentry occurred during the course of alternating Wenckebach periodicity; it could be invoked to explain the peculiar conduction patterns in this patient; and alternative mechanisms did not explain the alternating Wenckebach periods. Our findings also indicate that long conduction times during 2:1 block can be due to concealed reentry rather than concealed antegrade conduction, and participation in the echo process of a retrograde pathway with electrophysiologic characteristics of an atrioventricular nodal bypass tract does not exclude manifest and concealed reentry at a subatrial level.

  • References13
  • Citations4


Mentioned in this Paper

Biochemical Pathway
Heart Block
Left Bundle Branch of His
Cardiac Conduction System
Structure of Atrioventricular Node
NODAL gene
Heart Atrium
Cardiac Pacing, Artificial
Cardiac Conduction
Electrocardiographic Recorders

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