The patient was a 76-year old man with hypertension and hypercholesterolemia. In the electrocardiogram performed during a preoperative procedure for inguinal hernioplasty, first-degree atrioventricular block was observed. On questioning, the patient reported no dyspnea, palpitations, dizziness, or syncope. An exercise test and a Holter-ECG were requested. During the exercise test, the traces shown in the Figure were recorded.
In view of the results, we can consider 4 diagnostic options:
- 1.
PR interval shortening due to enhanced atrioventricular node conduction
- 2.
Appearance of nodal rhythm
- 3.
Marked PR prolongation, reaching 560ms with P waves conducted by the second QRS complex (known as over-the-top phenomenon)
- 4.
Accessory pathway conduction
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