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Haryadi

 The atria and ventricles are contiguous structures
separated by a dense mass of fibrous tissues that are
electrically inert.
 This prevents the direct spread of electrical impulses
between the atria and ventricles.
 The only pathway by which the sinus impulse can reach
the ventricles is through the normal atrioventricular (AV)
conduction system

or third degree (complete)?  What is the most likely level of the block: is it in the AV node (nodal) or below the AV node.Clinicians should try to answer two key questions when examining the ECG of a patient with apparent AV heart block:  What is the degree of block: What is the degree of block: is it first. second. in the His–bundle branch system (infranodal)? .

always conduct . note the prolonged PR interval  No drop beat.

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The Wenckebach cycle also produces a distinct clustering of QRS complexes separated by a pause (the dropped beat).1. . 3. Progressive lengthening of the PR interval from beat to beat until a beat is dropped. May be grouping of QRS complexes. 2. The PR interval after the nonconducted P wave is shorter than the PR interval before the nonconducted P wave.

Characteristic feature is : 1. Sudden appearance of a single. non- conducted sinus P wave without :  the progressive prolongation of the PR intervals seen in classic Mobitz type I  the shortening of the PR interval in the beat after the non-conducted P wave (as seen with type I block). .

 Location of Atrioventricular (AV) Block. and distal conduction system. . The lines transecting the AV conduction system indicate the potential sites of AV block. bundle branches.  In type II second-degree AV block (B). the AV block is almost always at the AV node although it can also occur anywhere in the His-Purkinje system. the AV block occurs exclusively at the bundle of His.  In type I second-degree AV block or AV Wenckebach (A).

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 Often are type II blocks  Sometimes they are labeled a “second degree block” only  Two or more consecutive non-conducted sinus P waves  Note the consistent PR intervals .

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QRS complexes may be normal widht or abnormally wide .1. In the case of flutter or atrial fibrillation as basic rhytm. the ventricular rate is very slow and almost completely regular. The P wave bears no relation to the QRS complexes. with a regular atrial rate faster than the ventricular rate. 2. 5. P waves are present. 3. with a slow (usually fixed) ventricular rate. and the PR intervals are completely variable because the atria and ventricles are electrically disconnected. 4. QRS complexes are present.

It can involve both bundle branches simultaneously or the right bundle plus both fascicles of the left bundle branch. . Complete Atrioventricular (AV) Block.  It can occur at the AV node or bundle of His.  Complete AV block can occur anywhere along the AV conduction system.

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will be conducted. and actual complete heart block result from true conduction failure.  AV dissociation resulting from of “desynchronization”. even if properly timed. This situation is similar to what occurs with complete heart block.AV is pacing the ventricles  Ventricular rate is similar to atria rate  No P wave.  SA node loses its normal control of the ventricular rate. . SA is pacing the atria .

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 Terimakasih .