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Address reprint requests and correspondence: Dr Timothy W. Smith, Cardiovascular Division, Washington University in St. Louis School of Medicine, 660 S Euclid Avenue, MSC 8086-43-13, St. Louis, MO 63110.
A 12-lead electrocardiogram (ECG) was obtained from a 73-year-old woman after laparoscopic
gastric bypass surgery (Figure 1). The ECG reveals an ectopic atrial tachycardia with a cycle length of 360 ms. There
is second-degree atrioventricular block in a 3:2 pattern. The second PR interval of
each 3:2 period is longer than the first, so the block is of the Wenckebach (Mobitz
1) type. In every other Wenckebach cycle, the second QRS complex is conducted with
right bundle branch block (RBBB) aberrancy. What is the mechanism of this pattern
of aberrancy?
Figure 1Electrocardiogram recorded in the hospital.
