Hisian extrasystole mimicking second degree atrioventricular block. a case report

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Published Nov 15, 2017
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Vol. 95 No. 2 (2017): Issue Feb 2017

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Dorra Mbarek
Soufia Naccache
Meya Abdallah
Rami Tlili
Youssef Ben Ameur
Mohamed Rachid Boujnah

Abstract

Hisian extrasystoles originate from the His bundle. They are rare and usually misdiagnosed. In fact, they manifest on the EKG, with a p’ wave
located before, in or after the QRS complex. More rarely, the extrasystole blocks the propagation of the influx to the ventricles simulating a Mobitz
II atrioventricular (AV) block. We report the case of a 36-Year-old woman with no medical History, suffering from presyncope and palpitations at
rest. Her physical examination and EKG were normal. The 24-hour Holter monitoring showed some long periods with unexpected blocked p
waves but with no significant pause. Considering her young age and the absence of causes of AV block, we performed an intracardiac
electrophysiological study which showed hisian extrasystoles with normal conduction tissue properties at baseline and under flecainide. The
diagnosis of hisian extrasystoles simulating Mobitz II AV block was made. A simple monitoring with beta-blockers therapy was recommended.
Hisian extrasystoles may simulate first or second degree AV block with different therapeutic and prognostic implications. Nevertheless,

Keywords:

Hisian extrasystoles, atrioventricular block, intracardiac electrophysiology study

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