Abstract
BACKGROUND: The Wenckebach phenomenon of atrioventricular conduction is deemed a physiological response of the atrioventricular node to a high atrial rate. However, the reverse Wenckebach phenomenon is under-recognized. CASE SUMMARY: We report an instance of reverse Wenckebach phenomenon developing into complete heart block in a 33-year-old man who experienced syncope after surgical repair of prolapsed bicuspid aortic valves. His condition was managed by temporary pacing. However, long-term follow-up demonstrated that the reverse Wenckebach phenomenon and severe heart block was reversible, avoiding the need for a permanent pacemaker. DISCUSSION: Reverse Wenckebach phenomenon can occur spontaneously and degenerate to complete heart block. Combined with our findings, early recognition and prompt intervention may save the patient at risk. TAKE-HOME MESSAGES: The reverse Wenckebach phenomenon paradoxically indicates an atrioventricular block at the intra-Hisian or infra-Hisian level, heralding a more severe atrioventricular block in the near future. This phenomenon after valve surgery may be temporary.