Reversible Wenckebach type atrioventricular block associated with severe coronary artery disease.

HIGH-grade atrioventricular heart block in patients with coronary artery disease is generally thought to be irreversible and in most cases atropine produces little or no effect.' Nevertheless, the possibility of significant vagal action should always be considered in any patient with heart block. When such a factor is present, the administration of atropine will produce a striking improvement in atrioventricular conduction. We are presenting detailed observations on an unusual patient with heart block: chronic atrioventricular block of the Wenckebach type was associated with severe coronary artery disease and congestive heart failure; atropine abolished the block, prevented Stokes-Adams attacks, and controlled an increase in the block that was produced by digitalis. These observations indicate that there may be functional as well as organic components in this type of heart block, and emphasize the importance of testing the ef. fects of atropine in such patients.