{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T03:17:20Z","timestamp":1792898240868,"version":"4.5.0"},"reference-count":10,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2017,9,20]],"date-time":"2017-09-20T00:00:00Z","timestamp":1505865600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pacing Clinical Electrophis"],"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Paroxysmal atrioventricular (A\u2010V) block is relatively rare, and due to its transient nature, it is often under recognized. It is often triggered by atrial, junctional, or ventricular premature beats, and occurs in the presence of a diseased His\u2010Purkinje system (HPS). Here, we present a 45\u2010year\u2010old white male who was admitted for observation due to recurrent syncope and near\u2010syncope, who had paroxysmal A\u2010V block. The likely cellular electrophysiological mechanisms(s) of paroxysmal A\u2010V block and its differential diagnosis and management are discussed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Continuous electrocardiographic monitoring was done while the patient was in the cardiac unit.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Multiple episodes of paroxysmal A\u2010V block were documented in this case. All episodes were initiated and terminated with atrial\/junctional premature beats. The patient underwent permanent pacemaker implantation and has remained asymptomatic since then.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Paroxysmal A\u2010V block is rare and often causes syncope or near\u2010syncope. Permanent pacemaker implantation is indicated according to the current guidelines. Paroxysmal A\u2010V block occurs in the setting of diseased HPS and is bradycardia\u2010dependent. The detailed electrophysiological mechanisms, which involve phase 4 diastolic depolarization, and differential diagnosis are discussed.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pace.13187","type":"journal-article","created":{"date-parts":[[2017,8,28]],"date-time":"2017-08-28T14:22:36Z","timestamp":1503930156000},"page":"1234-1241","source":"Crossref","is-referenced-by-count":23,"title":["Paroxysmal atrioventricular block: Electrophysiological mechanism of phase 4 conduction block in the His\u2010Purkinje system: A comparison with phase 3 block"],"prefix":"10.1111","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7969-9130","authenticated-orcid":false,"given":"Mohammad","family":"Shenasa","sequence":"first","affiliation":[{"name":"Heart &amp; Rhythm Medical Group  San Jose CA USA"},{"name":"O'Connor Hospital  San Jose CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark E.","family":"Josephson","sequence":"additional","affiliation":[{"name":"Harvard\u2010Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center Harvard Medical School  Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew L.","family":"Wit","sequence":"additional","affiliation":[{"name":"Department of Pharmacology Columbia University College of Physicians and Surgeons  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,9,20]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2009.04.001"},{"key":"e_1_2_5_3_1","first-page":"163","volume-title":"ECG Handbook of Contemporary Challenges","author":"Miller J","year":"2015"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2009.06.025"},{"key":"e_1_2_5_5_1","first-page":"126","volume-title":"The Conduction System of the Heart. Structure, Function, and Clinical Implications","author":"Rosenbaum M","year":"1976"},{"key":"e_1_2_5_6_1","first-page":"360","volume-title":"The Conduction System of the Heart. Structure, Function, and Clinical Implications","author":"Elizari M","year":"1976"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02758773"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.41.6.947"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-1-4557-2856-5.00105-9"},{"key":"e_1_2_5_10_1","volume-title":"The Conduction of the Nervous Impulse","author":"Hodgkin AL","year":"1964"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.46.3.528"}],"container-title":["Pacing and Clinical Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fpace.13187","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.13187","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,24]],"date-time":"2023-09-24T07:11:29Z","timestamp":1695539489000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pace.13187"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,9,20]]},"references-count":10,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2017,11]]}},"alternative-id":["10.1111\/pace.13187"],"URL":"https:\/\/doi.org\/10.1111\/pace.13187","archive":["Portico"],"relation":{},"ISSN":["0147-8389","1540-8159"],"issn-type":[{"value":"0147-8389","type":"print"},{"value":"1540-8159","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,9,20]]}}}