Various triggers of phase 4 block

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Various triggers of phase 4 block Jae-Sun Uhm, MD, PhD, Boyoung Joung, MD, PhD, Hui-Nam Pak, MD, PhD, Moon-Hyoung Lee, MD, PhD HeartRhythm Case Reports Volume 4, Issue 5, Pages 197-199 (May 2018) DOI: 10.1016/j.hrcr.2018.02.003 Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 1 A: Case 1: Atrioventricular block (AVB) in a 72-year-old man initiated with prolongation of the P-P interval (890 to 1200 ms) (arrow with solid line). Atrioventricular conduction resumed with junctional escape beat (arrow with broken line). B: Case 2: AVB in a 73-year-old man following coronary artery bypass surgery for myocardial infarction. Electrocardiography (ECG) on postoperative day (POD) 1 showed that paroxysmal AVB appeared following premature ventricular contraction (PVC) (arrow with solid line) and was terminated by fascicular escape beat (arrow with broken line). C: Case 3: ECG of a 69-year-old man post double valve replacement for severe mitral and aortic stenosis 10 years prior. ECG shows atrial flutter and 4.7-second ventricular pause after PVC (arrow) observed during sleep. Because he did not have symptomatic ventricular pause, we decided not to implant a pacemaker. D: Case 4: POD 14 ECG of a 68-year-old man who underwent aortic valve replacement for severe aortic stenosis. ECG showed that paroxysmal AVB appeared following premature atrial contraction (arrow with solid line) and was terminated by PVC (arrow with broken line). E: Case 4: After a temporary pacemaker was turned on, ECG monitoring showed that paroxysmal AVB followed supraventricular tachycardia (arrow with solid line), which was terminated by the ventricular pacing beat (arrow with broken line). F: Case 5: POD 7 ECG of a 71-year-old man who underwent aortic valve replacement and coronary artery bypass surgery. ECG showed that paroxysmal AVB appeared following termination of atrial fibrillation (arrow with solid line) and was terminated by PVC (arrow with broken line). HeartRhythm Case Reports 2018 4, 197-199DOI: (10.1016/j.hrcr.2018.02.003) Copyright © 2018 Heart Rhythm Society Terms and Conditions