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Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2018;71:115 - Vol. 71 Num.02 DOI: 10.1016/j.rec.2017.10.020

ECG, February 2018

Pablo Elpidio García-Granja a,b,, María Sandín Fuentes a,b, Emilio García-Morán a,b

a Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain
b CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain

Refers to

Free articleResponse to ECG, February 2018
Pablo Elpidio García-Granja, María Sandín Fuentes, Emilio García-Morán
Rev Esp Cardiol. 2018;71:207
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A 68-year-old man with no known cardiovascular risk factors or relevant personal or family history was referred to the cardiology outpatient clinic by his primary care physician for an incidental finding of extrasystoles in the electrocardiogram (Figure). He did not show any cardiac symptoms. Structural heart disease was ruled out with transthoracic echocardiography. Treatment with β-blockers was initiated and a Holter study was requested. This showed monomorphic extrasystoles in 31% of beats.


Which mechanism can explain his electrocardiogram?

1. Second-degree 2:1 atrioventricular (AV) block caused by disease intrinsic to the conduction system

2. Sinus P waves blocked by incomplete penetration of the ventricular extrasystole in the bundle of His

3. Atrial premature extrasystoles blocked by a refractory AV node

4. Ventricular extrasystoles with retrograde conduction to the atrium

Submit your diagnosis to The diagnosis will follow in the next issue (March 2018). #RetoECG.

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1885-5857/© 2018 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved