PubMed · 14333110
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C HAHN. 1965. [ELECTRICAL STIMULATORS].. https://pubmed.ncbi.nlm.nih.gov/14333110/
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The appearance of syncope in a patient with an accessory pathway is often a sign of high conduction capacity along the pathway, and calls for urgent ablation. Serious complications may ensue if it is assumed that these patients have an underlying mechanism of tachyarrhythmia, and ablation of the accessory pathway performed hastily without careful electrophysiological evaluation may lead to serious complications. The case described here, despite the patient's unusual presenting features, illustrates that the causal mechanism of syncope is not always what it appears to be. Although our patient had an obvious accessory pathway that was clearly evident in the electrocardiogram, the actual cause of the problem was complete infrahissian atrioventricular block.
Bradyarrhythmia requiring permanent pacing after heart transplantation remains a common problem. Sinus node dysfunction is the most common indication, and late onset of atrioventricular (AV) block has rarely been reported. We report the case of a patient who developed advanced AV block at 41 months after transplantation. Right bundle branch block with progressive increase of QRS complex duration was noted in serial electrocardiograms. At the time of late AV block development, the patient did not have acute rejection and coronary angiogram was normal. The mechanism of late onset of AV block is unclear, but it may be caused by progressive conduction.