Abstract

We present a case of a 75-year-old lady with effort intolerance and baseline ECG showing 2:1 atrioventricular block, in whom it was unclear as to the requirement of permanent pacing, even after long term ECG monitoring. She underwent a treadmill test during which her QRS became wide and developed complete heart block within 2 minutes of the test. Thus, a simple exercise test confirmed the level of the block to be infra nodal without the need for the invasive study. In patients with exertional symptoms, even in elderly, and in those where ECG masquerades as a benign entity, exercise testing is useful to differentiate benign cases of atrioventricular block from the more serious cases that mandate pacemaker implantation.

Keywords: Atrioventricular block, Complete heart block, Exercise test, Intra-Hisian block, Infra nodal, Coronary angiogram.