Clinical Case Database / Category: Patient Management

Interpreting atrioventricular block

Publication details

Dr Matthew R Webber, FRACP, MBChB, Dr Mark CS Hall, MD, FRCP, MRCP, MBBS
Foundation Years Journal, volume 7, issue 6, p.26 (123Doc Education, London, June 2013)


A 23 year-old man presents with palpitations and presyncope with evidence of non-conducted P waves at low heart rates, and frequent narrow-complex tachycardia. A dual chamber pacemaker was implanted for presumed sinus node dysfunction, second-degree atrioventricular (AV) block and atrial flutter. Many years and two pacemaker generator changes later he underwent an electrophysiology study that revealed normal AV node and His-Purkinje function, a concealed accessory pathway, and orthodromic atrioventricular reentrant tachycardia. We scrutinize his case, discuss AV conduction anomalies, and consider an alternative investigation strategy

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Dr Matthew R Webber, FRACP, MBChB

Cardiology Department
Liverpool Heart and Chest Hospital

Dr Mark CS Hall, MD, FRCP, MRCP, MBBS (Corresponding author)

Cardiology Department
Liverpool Heart and Chest Hospital


1. Hampton JR, Frcp DMD. The ECG made easy. Churchill Livingstone; 1992.
2. Hampton JR, Adlam D. The ECG in practice. Churchill Livingstone; 2008.


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T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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