Abstract
A 12-lead electrocardiogram was obtained in a 73-year-old woman after laparoscopic gastric bypass surgery (Figure 1). The electrocardiogram reveals an ectopic atrial tachycardia with a cycle length of 360 ms. There is 2nd degree AV block in a 3:2 pattern. The second PR interval of each 3:2 period is longer than the first, so the block is of the Wenckebach (Mobitz 1) type. In every other Wenckebach cycle, the second QRS is conducted with right bundle branch block aberrancy. What is the mechanism of this pattern of aberrancy?
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