A rare association of complete atrio-ventricular block and preexcitation: case report

Complete atrioventricular block (AVB) associated with an accessory pathway is a rare phenomenon. We report a case of high degree AVB on Wolff Parkinson White (WPW) syndrome associated with an accessory pathway in a 60-year-old female patient. The electrocardiogram (ECG) on admission showed a regular sinus rhythm with a short PR interval and a QRS notch with a transition to conductive disturbances, specifically a complete AVB and a transition to a 2/1 AVB. The patient underwent endocavitary exploration, which revealed a pre-excitation in the right anteroseptal position with a long refractory period, justifying its non-ablation. She then underwent implantation of a double-chamber pacemaker with simple follow-up and regular monitoring in the rythmology clinic. This case report describes this rare association and highlights the conduction duality of the normal nodo-hissian pathway and the accessory pathway