CORRESPONDENCE: LETTERS TO THE EDITOR
Reversible atrioventricular block and the Amplatzer device
Benjamin M. Kaplan, MD, FACC* and
Pablo Denes, MD, FACC
* Northwestern Memorial Hospital, Division of Cardiology, 676 North St. Clair, Suite 1930, Chicago, IL 60611 (Email: b-kaplan{at}northwestern.edu).
We read with great interest the recent study by Suda et al. (1), entitled "Reversible Atrioventricular Block Associated With Closure of Atrial Septal Defects Using the Amplatzer Device." We disagree with their interpretation of the upper electrocardiograph rhythm strip in Figure 1. Our interpretation would be that of sinus rhythm with 3:2 second-degree atrioventricular (AV) block with Wenckebach periods (2), not "complete" AV block. The 3rd, 6th, 9th, 12th, and 15th P waves are nonconducted, giving rise to bigeminal rhythm. An alternate interpretation would be second-degree AV block with accelerated junctional escapes (3).
Finally, we agree that the lower rhythm strip shows normal AV conduction, the minimum irregularity being due to a slight sinus arrhythmia.
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References
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1. Suda K, Raboisson M-J, Piette E, Dahdah NS, Miro J. Reversible atrioventricular block associated with closure of atrial septal defects using the Amplatzer device J Am Coll Cardiol 2004;43:1677-1682.[Abstract/Free Full Text]
2. Denes P, Levy L, Pick A, Rosen KM. The incidence of typical and atypical A-V Wenckebach periodicity Am Heart J 1975;89:26-31.[CrossRef][Web of Science][Medline]
3. Pick A, Langendorf R. Interpretation of Complex ArrhythmiasPhiladelphia, PA: Lea and Febiger; 1979.
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