ArticleJACC. Case reports2026
A Premature Ventricular Complex as Both Culprit and Cure: Paroxysmal Intrinsic Atrioventricular Block.
Article in JACC. Case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundParoxysmal atrioventricular block (AVB) due to phase 4 depolarization of the His-Purkinje system is an uncommon but clinically important cause of syncope and ventricular asystole. CASE SUMMARY: We report a case in which a premature ventricular complex (PVC) initiated infra-Hisian AVB, resulting in prolonged ventricular asystole despite ongoing sinus activity. Notably, recovery of atrioventricular conduction was triggered by a subsequent PVC. DISCUSSION: This case provides a clear mechanistic illustration of pause-dependent conduction failure and recovery in diseased His-Purkinje tissue. Recognition of this pattern is critical, as it reflects advanced conduction system disease and mandates permanent pacing. TAKE-HOME MESSAGE: PVC-initiated, and terminated, paroxysmal phase 4 AVB is a marker of advanced His-Purkinje disease and differentiates intrinsic phase 4 AVB from vagally mediated AVB and sinus arrest.
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