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    First Degree Atrioventricular Block

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    Shreyas Walvekar
    First degree atrioventricular block involves prolonged conduction through the AV node such that the PR interval is greater than 0.20 seconds, but every impulse is still conducted to the ventricles. There is no required treatment. Second degree AV block type I (Mobitz I) involves gradual lengthening of the PR interval prior to a blocked beat. Treatment may include atropine or a temporary pacemaker if symptomatic. Second degree AV block type II (Mobitz II) has a constant prolonged PR interval greater than 0.20 seconds with intermittent blocked beats. Pacemaker implantation is the treatment. Third degree AV block is complete heart block where no impulses are conducted from the atria to the ventric

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    First Degree Atrioventricular Block

    Uploaded by

    Shreyas Walvekar
    63 views3 pages
    First degree atrioventricular block involves prolonged conduction through the AV node such that the PR interval is greater than 0.20 seconds, but every impulse is still conducted to the ventricles. There is no required treatment. Second degree AV block type I (Mobitz I) involves gradual lengthening of the PR interval prior to a blocked beat. Treatment may include atropine or a temporary pacemaker if symptomatic. Second degree AV block type II (Mobitz II) has a constant prolonged PR interval greater than 0.20 seconds with intermittent blocked beats. Pacemaker implantation is the treatment. Third degree AV block is complete heart block where no impulses are conducted from the atria to the ventric

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    First degree atrioventricular block involves prolonged conduction through the AV node such that the PR interval is greater than 0.20 seconds, but every impulse is still conducted to the ventricles. There is no required treatment. Second degree AV block type I (Mobitz I) involves gradual lengthening of the PR interval prior to a blocked beat. Treatment may include atropine or a temporary pacemaker if symptomatic. Second degree AV block type II (Mobitz II) has a constant prolonged PR interval greater than 0.20 seconds with intermittent blocked beats. Pacemaker implantation is the treatment. Third degree AV block is complete heart block where no impulses are conducted from the atria to the ventric

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    © All Rights Reserved
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    63 views3 pages

    First Degree Atrioventricular Block

    Uploaded by

    Shreyas Walvekar
    First degree atrioventricular block involves prolonged conduction through the AV node such that the PR interval is greater than 0.20 seconds, but every impulse is still conducted to the ventricles. There is no required treatment. Second degree AV block type I (Mobitz I) involves gradual lengthening of the PR interval prior to a blocked beat. Treatment may include atropine or a temporary pacemaker if symptomatic. Second degree AV block type II (Mobitz II) has a constant prolonged PR interval greater than 0.20 seconds with intermittent blocked beats. Pacemaker implantation is the treatment. Third degree AV block is complete heart block where no impulses are conducted from the atria to the ventric

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    First Degree Atrioventricular Block

    Here every impulse is conducted to the ventricles, but the duration of AV conduction is
    prolonged (Fig. 6.25).

    ECG Characteristics

    • Rate: Can occur at any sinus rate, usually 60 to 100 beats/min.

    •Rhythm: Regular

    •P waves: Normal; precede every QRS.

    •PR interval: Greater than 0.20 second.

    •QRS complex: Usually normal, unless bundle-branch block exists.

    •Conduction: Normal through the atria, delayed through the AV node, normal through the
    ventricles.

    Treatment

    There is no treatment required for first degree AV block.

    Second Degree AV Block Type I

    Type I second degree AV block (Mobitz I or Wenckebach heart block) includes a gradual
    lengthening of the PR interval followed by missed or blocked beat (Fig. 6.26). ^

    ECG Characteristics

    •Rate: Atrial rate is normal, but ventricular rate may be slower as a result of nonconducted or
    blocked QRS complexes.

    •Rhythm: Irregular unless 2:1 conduction is present.

    •P waves: Normal. Some P waves are not conducted to the ventricles, but only one at a time
    fails to conduct.

    •PR interval: Gradually lengthening of PR interval in consecutive beats.

    •QRS complex: Usually normal unless there is associated bundle branch block.

    •Conduction: Normal through the atria, progressively delayed through the AV node until an
    impulse fails to conduct. Ventricular conduction is normal.
    Treatment

    If the patient is symptomatic, atropine is used to increase HR or a temporary pacemaker may


    be needed especially if the patient has experienced an MI. If the patient is asymptomatic the
    rhythm should be closely observed with a transcutaneous pacemaker on standby. ^

    Second Degree AV Block Type II

    In type II second degree AV block (Mobitz II heart block), PR interval is constant and is
    greater than 0.20 second, followed by missed or blocked beat (Fig. 6.27).

    ECG Characteristics

    •Rate: Atrial rate is usually normal. Ventricular rate depends on the intrinsic rate and the
    degree of AV block.

    •Rhythm: Atrial rhythm is regular, but ventricular rhythm may be irregular.

    •P waves: Usually regular and precede each QRS. Periodically, a P wave is not followed by a
    QRS complex.

    •PR interval: Constant (prolonged greater than 0.20 second) before all conducted beats.

    •QRS complex: Almost always wide because of associated bundle branch block

    •Conduction: Normal through the atria and through the AV node, but intermittently blocked
    in the bundle branch system and fails to reach the ventricles. Conduction through the
    ventricles is abnormally slow because of associated bundle branch block. Conduction ratios
    can vary from 2:1 to only occasional blocked beats

    Treatment

    Pacemaker implantation.

    Third Degree AV Block

    Third degree AV block or complete heart block constitutes one form of AV dissociation in
    which no impulses from the atria are conducted to the ventricles (Fig. 6.28). The atria are
    stimulated and contract independently of the ventricles. The ventricular rhythm is an escape
    rhythm and the ectopic pacemaker may be above or below the bifurcation of the bundle of
    His.

    ECG Characteristics

    Rate: Atrial rate is 60 to 100 beats/minute. The ventricular rate is 40 to 60 beats/minute.

    Rhythm: Regular.

    P waves: Normal, but dissociated from QRS complexes.


    PR interval: The PR interval is variable and there is no time relationship between the P wave
    and the QRS complex. QRS complex: Normal if ventricles controlled by a junctional
    pacemaker, wide if controlled by a ventricular pacemaker.

    Conduction: Normal through the atria. All impulses are blocked at the AV node or in the
    bundle branches, so there is no conduction to the ventricles. Conduction through the
    ventricles is normal if a junctional escape rhythm occurs and is abnormally slow if a
    ventricular escape rhythm occurs.

    Treatment

    Pacemaker implantation

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