Block

of a Single/Mul1ple P waves
&
Anatomical Level of Block

Dr Ulhas Pandurangi
Chief: Cardiac Electrophysiology and Pacing
The Madras Medical Mission

Second Degree ( Mobitz) Block

Type I

Type II

Second Degree ( Mobitz) Type I Block

AV Nodal (SupraHisian) disease

A wide QRS suggests addi1onal BBB or FB

Second Degree ( Mobitz) Type II Block

Almost always IntraHisian/InfraHisian Disease

Second Degree ( Mobitz) Type II Block

Rules:
No sinus slowing
No shortening of PR following the pause
No co-existence of Type I and Type II blocks

Second Degree ( Mobitz) Type II Block

Rules:
No sinus slowing
No shortening of PR following the pause
No co-existence of Type I and Type II blocks

Second Degree ( Mobitz) Type II Block

Rules:
No sinus slowing
No shortening of PR following the pause
No co-existence of Type I and Type II blocks

Second Degree ( Mobitz) Type II Block

Rules:
No sinus slowing
No shortening of PR following the pause
No co-existence of Type I and Type II blocks

Second Degree ( Mobitz) Type II Block

70% : Wide QRS (InfraHisian)
30% : Narrow QRS (IntraHisian)
Pacemaker indicated

Second Degree ( Mobitz) Block Mimicks:

Pseudo AV Blocks

Concealed extrasystole

Paroxysmal AV Block

Bradycardia Dependent
(Phase IV Block)
Always infranodal

Indica1ons for EP Study

Asymptoma1c type I second-degree AV block
with bundle branch block
Ques1onable diagnosis of type II block with a
narrow QRS complex
Paroxysmal AV Block with Suspicion of
concealed AV junc1onal or ventricular
extrasystoles

Thank -You