Jin Cui-Xiong, Zhu Yi-Ming, Guo Xiao-Gang
Fuwai Yunnan Hospital, Chinese Academy of Medical Sciences/Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, China.
Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
JACC Case Rep. 2025 Sep 3;30(26):104901. doi: 10.1016/j.jaccas.2025.104901.
The Wenckebach phenomenon of atrioventricular conduction is deemed a physiological response of the atrioventricular node to a high atrial rate. However, the reverse Wenckebach phenomenon is under-recognized.
We report an instance of reverse Wenckebach phenomenon developing into complete heart block in a 33-year-old man who experienced syncope after surgical repair of prolapsed bicuspid aortic valves. His condition was managed by temporary pacing. However, long-term follow-up demonstrated that the reverse Wenckebach phenomenon and severe heart block was reversible, avoiding the need for a permanent pacemaker.
Reverse Wenckebach phenomenon can occur spontaneously and degenerate to complete heart block. Combined with our findings, early recognition and prompt intervention may save the patient at risk.
TAKE-HOME MESSAGES: The reverse Wenckebach phenomenon paradoxically indicates an atrioventricular block at the intra-Hisian or infra-Hisian level, heralding a more severe atrioventricular block in the near future. This phenomenon after valve surgery may be temporary.
房室传导的文氏现象被认为是房室结对高心房率的一种生理反应。然而，逆向文氏现象却未得到充分认识。
我们报告了一例33岁男性患者，在二叶式主动脉瓣脱垂手术修复后出现晕厥，其逆向文氏现象发展为完全性心脏传导阻滞。他的病情通过临时起搏进行处理。然而，长期随访表明逆向文氏现象和严重心脏传导阻滞是可逆的，无需植入永久性起搏器。
逆向文氏现象可自发发生并恶化为完全性心脏传导阻滞。结合我们的研究结果，早期识别和及时干预可能挽救处于危险中的患者。
逆向文氏现象反常地提示希氏束内或希氏束下水平的房室传导阻滞，预示着在不久的将来会出现更严重的房室传导阻滞。瓣膜手术后的这种现象可能是暂时的。
