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A hypertensive old man in his 80s with no other known comorbidities presented with exertional fatigue for 3 months and an episode of presyncope 2 days prior to presentation. Bradycardia (heart rate of 45/min) was detected during blood pressure measurement, and a 12-lead ECG revealed 2:1 atrioventricular block with complete right bundle branch block (RBBB) and normal PR interval on conducted beats (figure 1A). Echocardiography demonstrated a structurally normal heart. In view of probable infrahisian atrioventricular block and symptomatic status, he underwent dual-chamber permanent pacemaker implantation. Postpacemaker implantation ECG is shown in figure 1B. …
Contributors SKN and RB were involved in data acquisition, interpretation, design and writing. GS was involved in writing, critical revision for intellectual content and final approval of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, r conduct, reporting or dissemination plans of this research.
Provenance and peer review Not commissioned; internally peer reviewed.
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