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Vol. 70. Issue 11.
Pages 1009 (November 2017)
ECG Contest
DOI: 10.1016/j.rec.2017.03.017
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Response to ECG, October 2017
Respuesta al ECG de octubre de 2017
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Carlos Rubén López Perales
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caruben89@gmail.com

Corresponding author:
, Georgina Fuertes Ferre, Juan Carlos Porres Azpiroz
Servicio de Cardiología, Hospital Universitario Miguel Servet, Zaragoza, Spain
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Rev Esp Cardiol. 2017;70:87010.1016/j.rec.2017.04.005
Carlos Rubén López Perales, Georgina Fuertes Ferre, Juan Carlos Porres Azpiroz
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Conduction via an accessory pathway (option 1) can be ruled out given the absence of pre-excitation in most of the complexes (narrow QRS) and the presence of nonconducted P waves (unlikely simultaneous block of conduction system and accessory pathway).

Moreover, although extrasystoles of ventricular origin are present, the atrial cycle is maintained, and so the electrocardiogram (ECG) cannot be considered a premature atrial complex (option 2).

Option 3 is ruled out given that nonconducted atrial complexes coincide with a prior ventricular extrasystole, and so the ventricular extrasystole has to be involved in the origin of the phenomenon.

The correct solution is option 4. The ECG shows atrial rhythm of low origin with a 760ms cycle. Twice, the ventricular extrasystole is transmitted in retrograde direction, leading to a refractory period in the atrioventricular node. This blocks conduction of the next atrial pulse (Figure).

Figure.

Lewis diagram showing retrograde atrioventricular conduction.

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Copyright © 2017. Sociedad Española de Cardiología
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