Manifest and Concealed Reentry A MECHANISM OF AV NODAL WENCKEBACH PHENOMENON

The mechanism of the AV nodal Wenckebach phenomenon was studied in 25 dogs by multiple atrial and His bundle electrogram (HBE) recordings. During ventricular stimulation with 1:1 retrograde conduction, the interval from the stimulus artifact to the retrograde His deflection (S-H interval) remained constant. Decreasing the cycle length of stimulation (CLS) resulted in retrograde AV nodal Wenckebach cycles. When retrograde AV nodal delay reached a critical value, the Wenckebach cycles were terminated by a reciprocal beat (manifest reentry). The His bundle and ventricles were antegradely depolarized by the reentrant impulse. A further decrease in CLS produced what electrocardiographically looked like ordinary Wenckebach cycles. However, the HBE tracing revealed that reentry was occurring but was concealed by the CLS. This was confirmed by noting that the His deflection of the last ventricular paced beat of the Wenckebach cycle was antegradely depolarized and had a shorter S-H interval than all other beats of that cycle