Castellanos A, Moleiro F, Saoudi N, Interian A, Myerburg R J
University of Miami School of Medicine, Florida 33101, USA.
Am J Cardiol. 1995 Sep 1;76(7):523-5. doi: 10.1016/s0002-9149(99)80145-3.
In summary, the irregular dynamics of progression of 4:1 AV block in atrial flutter, presumably different from those observed in similar degrees of rate-dependent block, most likely reflected the complex electrophysiologic mechanisms operating during the highest degrees of AV nodal block. Occurrence of previously undescribed arrhythmias, namely Wenckebach periods during 4:1 and 6:1 block, tends to support the multilevel block hypothesis.