JACC. Case reports · 2026
Sequential Electrocardiographic Progression of Alternating Bundle Branch Block Culminating in Complete Atrioventricular Block.
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Goodwin Ashley S, Martinez-Parachini Jose Roberto, Engels Marc C, Lehmann Immo, Konstantinidis Klitos, Ranjan Ravi, Freedman Roger, Bunch T Jared
Аннотация
BACKGROUND: Alternating bundle branch block (ABBB) is defined by a transient spontaneous block in the right and left bundles (including left anterior or posterior fascicles) diagnosed on consecutive electrocardiogram (ECG) tracings.
CASE SUMMARY: A 74-year-old man with hypertension and a remote inferior myocardial infarction presented with fatigue and syncope. Initial ECG showed sinus rhythm with a first-degree atrioventricular block and ABBB. During hospital admission, he experienced syncope, and a subsequent ECG showed an unstable complete heart block. He was resuscitated with emergent transcutaneous pacing and underwent permanent pacemaker implantation.
DISCUSSION: This case captures a rare ECG demonstrating sequential ABBB, a harbinger for rapid progression to a high-degree atrioventricular block. According to American College of Cardiology/American Heart Association/Heart Rhythm Society and European Society of Cardiology Guidelines, pacing is a class 1 indication for ABBB with or without symptoms. Early recognition is essential for timely pacemaker implantation.
TAKE-HOME MESSAGES: ABBB represents significant infra-Hisian conduction disease with an increased risk for progression to a high-degree block. ABBB is a class 1 indication for pacemaker implantation.
CASE SUMMARY: A 74-year-old man with hypertension and a remote inferior myocardial infarction presented with fatigue and syncope. Initial ECG showed sinus rhythm with a first-degree atrioventricular block and ABBB. During hospital admission, he experienced syncope, and a subsequent ECG showed an unstable complete heart block. He was resuscitated with emergent transcutaneous pacing and underwent permanent pacemaker implantation.
DISCUSSION: This case captures a rare ECG demonstrating sequential ABBB, a harbinger for rapid progression to a high-degree atrioventricular block. According to American College of Cardiology/American Heart Association/Heart Rhythm Society and European Society of Cardiology Guidelines, pacing is a class 1 indication for ABBB with or without symptoms. Early recognition is essential for timely pacemaker implantation.
TAKE-HOME MESSAGES: ABBB represents significant infra-Hisian conduction disease with an increased risk for progression to a high-degree block. ABBB is a class 1 indication for pacemaker implantation.