{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T03:12:23Z","timestamp":1760238743729,"version":"build-2065373602"},"reference-count":7,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2022,7,19]],"date-time":"2022-07-19T00:00:00Z","timestamp":1658188800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"SCIENCE AND TECHNOLOGY DEPARTMENT OF DALIAN CITY","award":["2020JJ26SN055"],"award-info":[{"award-number":["2020JJ26SN055"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>A 70-year-old man with severe valvular cardiomyopathy, permanent atrial fibrillation (AF) with a slow ventricular response, and transient atrioventricular (AV) block, was admitted to our center for severe heart failure and recurrent presyncope. While hospitalized, the coronary computed tomography angiography (CTA) showed huge atriums. We tried His bundle pacing (HBP). HB potential was observed at site A, and the His-ventricular (HV) interval was 68 ms. The duration from the stimulus signal to the onset of paced QRS (S-QRSonset) at site A was 232 ms when pacing at 60 beats per minute (BPM) with the pacing threshold of 2.0 V\/0.5 ms. The S-QRSonset was longer than the HV interval and had a notable and progressive prolongation from 252 ms to 456 ms during the pacing at 90 BPM. Then, we pushed another lead a little forward, and the S-QRSonset shortened back to 68 ms, and the paced QRS morphology was the same as the intrinsic QRS morphology with the pacing threshold of 1.5 V\/0.5 ms. The progressively prolonged S-QRSonset demonstrated a Wenckebach phenomenon (WP), a well-known electrophysiological characteristic of the AV node (AVN). It is the first time to report an intraoperative AVN-pacing related-WP in a patient with persistent AF. The enlarged atrium might be convenient for capturing the AVN. There are some other potential explanations for this phenomenon. The diameters of atriums decreased significantly, and the symptoms improved after the procedure. This is the first reported case in which we might achieve AVN capture in a patient with persistent AF. Although we ultimately chose HBP for better long-term pacing thresholds, the result of this case suggested that AVN pacing may be possible.<\/jats:p>","DOI":"10.3390\/jcdd9070231","type":"journal-article","created":{"date-parts":[[2022,7,19]],"date-time":"2022-07-19T05:37:53Z","timestamp":1658209073000},"page":"231","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Case Report of a Wenckebach Phenomenon Occurring during a His-Bundle Pacing Procedure: Is It Atrioventricular Node Pacing?"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6259-4455","authenticated-orcid":false,"given":"Chengming","family":"Ma","sequence":"first","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9764-2709","authenticated-orcid":false,"given":"Wenwen","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yongmei","family":"Cha","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55421, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yunlong","family":"Xia","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lianjun","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yingxue","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,7,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1161\/CIRCRESAHA.108.172403","article-title":"Computer three-dimensional reconstruction of the atrioventricular node","volume":"102","author":"Li","year":"2008","journal-title":"Circ. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"181","DOI":"10.15420\/aer.2021.32","article-title":"The Atrioventricular Conduction Axis and its Implications for Permanent Pacing","volume":"10","author":"Cabrera","year":"2021","journal-title":"Arrhythmia Electrophysiol. Rev."},{"key":"ref_3","first-page":"443","article-title":"Miniseries 1\u2014Part II: The comparative anatomy of the atrioventricular conduction axis","volume":"24","author":"Tretter","year":"2022","journal-title":"EP Eur."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1016\/j.jacep.2018.12.012","article-title":"Intra-Hisian Wenckebach Phenomenon during His Bundle Pacing: A Hazard Associated with \u201cPrecision\u201d Medicine","volume":"5","author":"Anderson","year":"2019","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1111\/jce.13789","article-title":"Massive His bundle injury current corresponds with acute trauma and slowing of conduction that has to subside before pacing threshold assessment","volume":"30","author":"Moskal","year":"2019","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2319","DOI":"10.1016\/j.jacc.2018.02.048","article-title":"Clinical Outcomes of His Bundle Pacing Compared to Right Ventricular Pacing","volume":"71","author":"Abdelrahman","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1038\/s41569-019-0224-z","article-title":"Permanent His bundle pacing: Shaping the future of physiological ventricular pacing","volume":"17","author":"Sharma","year":"2020","journal-title":"Nat. Rev. Cardiol."}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/9\/7\/231\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:53:27Z","timestamp":1760140407000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/9\/7\/231"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,19]]},"references-count":7,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2022,7]]}},"alternative-id":["jcdd9070231"],"URL":"https:\/\/doi.org\/10.3390\/jcdd9070231","relation":{},"ISSN":["2308-3425"],"issn-type":[{"type":"electronic","value":"2308-3425"}],"subject":[],"published":{"date-parts":[[2022,7,19]]}}}