Diagnosis Wenckebach

Okay, so this made the rounds a little while ago, but I’m posting it nonetheless:

Amanda and I had a little bit of a communication difficulty when discussing this video. Apparently in medical terminology, at least for a 4th-year medical student, “Wenckebach” is only heard when referring to intermittent AV-nodal block (as deftly illustrated in the video). On the other hand, experimental electrophysiologists frequently refer to any situation in which one area is activating more rapidly than an adjacent area because of differences in refractory period “Wenckebach rhythm”, or if they’re more precise, “Wenckebach-like rhythm”. Many synonyms are also used.

Below is a video of electrical activation during ischemia, illustrating a Wenckebach-like rhythm.

As you can see in the video, the center of the model is only activated every other beat, while the periphery is activated every beat. This is typically referred to as “2:1 capture” or “Wenckebach-like rhythm”, even though the actual phenomenon has very little to do with a true Wenckebach rhythm, in which the atria are activated more rapidly than the ventricles, with block occurring intermittently at the AV-node. The “Diagnosis Wenckebach” has some cute diagrams and even stadium-wave-like demonstrations of this phenomenon.