Atrioventricular block with 3:1 conduction and subsequent dissociation. Case report
Keywords:
cardiac arrhythmias, cardiac resynchronization therapy devices, case reports, electrocardiography, heart block, p wave, sinoatrial nodeAbstract
Introduction: atrioventricular block is the loss of normal function of the specialized atrioventricular conduction system. In second-degree block, conduction is intermittently blocked. In advanced second-degree block, at least two consecutive P waves fail to conduct; and in complete block, there is a dissociation between atrial and ventricular depolarizations. In the specialized Cuban literature, no recent reports or studies on this cardiovascular condition were found.
Objective: to describe an unusual case of a patient with advanced second-degree atrioventricular block with 3:1 conduction who, after surgical intervention, presented atrioventricular dissociation.
Case presentation: a 42-year-old male patient with primary hypertension and ischemic heart disease (stable chronic angina), under treatment, presented in the past month with weakness, physical exhaustion, progressive dyspnea during mild exertion, and, on one occasion, a sudden loss of consciousness lasting two minutes. He was diagnosed with high-grade atrioventricular block and received a pacemaker implant. Subsequently, he presented atrioventricular dissociation, but his heart rate remained at 60 beats per minute.
Conclusions: a type of atrioventricular block rarely seen in individuals under 60 years of age was documented through imaging. Twelve-lead electrocardiograms and long lead II recordings enabled an accurate diagnosis of the condition and confirmed its progression to complete atrioventricular block after pacemaker implantation. This event may occur, but it is not commonly mentioned in the specialized literature. This makes the publication of this case report a valuable scientific contribution.
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