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Comment & Response
April 2019

AV Nodal Wenckebach Masquerading as Infra-His Wenckebach Due to Intra-atrial Conduction Delay–In Reply

Author Affiliations
  • 1University of California, Davis, Sacramento, California
  • 2Division of Cardiovascular Medicine, University of California, Davis Medical Center, Sacramento, California
JAMA Intern Med. 2019;179(4):588. doi:10.1001/jamainternmed.2018.8597

In Reply We would like to thank Dr Bansal for his comments regarding interpretation of the His electrogram in our Figure 2.1 We would agree that careful positioning of catheters such that their electrograms are present on the recording channel is important but we would disagree with his conjecture regarding our conclusions. On careful rereview of electrograms from the case, the evidence supports our initial conclusions of infra-Hisian Wenckebach block rather than intra-atrial conduction delay or AV nodal Wenckebach conduction block as speculated. We would like to first point out that the purpose of the intracardiac electrogram in the Figure 2 of the manuscript is to illustrate infra-Hisian conduction abnormalities for an audience of internal medicine physicians and therefore the most salient example of infra-Hisian Wenckebach block was included in the figure while excluding extraneous information (ie, additional electrograms recorded during the case) not focused on that point.

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