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