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Vol. 73. Issue 9.
Pages 768 (September 2020)
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Vol. 73. Issue 9.
Pages 768 (September 2020)
ECG Contest
DOI: 10.1016/j.rec.2019.12.019
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Response to ECG, August 2020
Respuesta al ECG de agosto de 2020
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Martín Ibarrola
Centro Cardiovascular BV, Buenos Aires, Argentina
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Rev Esp Cardiol. 2020;73:66310.1016/j.rec.2019.12.018
Martín Ibarrola
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The PR intervals shorten from beat to beat, until they are superimposed on the QRS complex. Negative T waves are normal until V4 in children and the QTc interval is normal. Another blocked P wave can be seen in the T wave, thus ruling out isorhythmic atrioventricular dissociation (responses 1, 2, and 4 incorrect). An atrial frequency of 100 bpm is observed along with nodal escape rhythm or infra-Hisian rhythm of 48 bpm (response 3, correct). The rhythm strip confirms diagnosis of complete atrioventricular block (figure 1). Cardiac malformation and maternal anti-Ro/SSA and anti-La/SSB antibodies should be ruled out.1 Studies (echocardiography, exercise testing, Holter study) are recommended to stratify the risk of sudden cardiac death and inform the need for permanent pacemaker placement.2

Figure 1
(0.94MB).
References
[1]
M. Michaelsson, A. Jonzon, T. Riesenfeld.
Isolated congenital complete atrioventricular block in adult life. A prospective study.
Circulation., 92 (1995), pp. 442-449
[2]
A.E. Baruteau, R.H. Pass, J.B. Thambo, et al.
Congenital and childhood atrioventricular blocks: pathophysiology and contemporary management.
Eur J Pediatr., 175 (2016), pp. 1235-1248
Copyright © 2019. Sociedad Española de Cardiología
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