Second Degree Heart Block Associated with QT Prolongation

Pseudo 2:1 AV block when sinus intervals are shorter than the ventricular refractory period has been reported with long QT syndrome (LQTS). We report the characteristics and treatment of a patient suffering from congenital LQTS with episodes of true 2:1 AV block. The pseudo 2:1 AV block relates to the extreme prolongation of ventricular refractoriness. Several histologic studies have documented abnormalities within the conduction system, including apoptosis. Because of the rare occurrence and poor prognosis of the LQTS with impaired AV conduction, international guidelines for diagnosis and treatment are needed.