ECG Atrioventricular

conduction
Dr. David D. Ariwibowo SpJP, FIHA
Pacemaking & conduction System
Journal of the American College of Cardiology Vol. 38, No. 7, 2001
 1st degree AV Block

Rhythm : depends on underlying rhythm

Rate : depends on underlying rhythm
P Waves: upright and uniform; each P wave will be followed by a QRS complex
PRI : > .20 seconds; constant across the strip
QRS : < .12 seconds
 Second -degree AV block,
Mobitz I
Rhythm : Irregular
Rate : Usually slow but can be normal
P wave : Sinus P wave present;
some not followed by QRS complexes
PR : Progressively lengthens
QRS : Normal
 Second-degree AV block,
Mobitz II
Rhythm : Regular usually; can be irreguler if conduction ratios vary
Rate : Usually slow
P wave : Two, three, or four P waves before each QRS
PR : PR interval of beat with QRS is constant; PR interval may be
normal or prolonged
QRS : Normal if block in His bundle; wide if block involves bundle
branches
Mobitz I
 10

2 to 1 AV block
every other P wave is conducted to the ventricles
2 to 1 AV block starts after the 5th QRS in this 3 channel recording. The first non-
conducted P wave is indicated with an arrow.
the PR interval of conducted P waves is constant
in this lady there is a long PR interval (and left bundle branch block)
2 to 1 AV block cannot be classified into Mobitz type I or II as we do not know if the 2nd P
wave would be conducted with the same or longer PR interval.
High-grade atrioventricular block
 Third-degree AV block
Rhythm : Regular
Rate : 40 60 if block in His bundle;
30 40 if block involves bundle branches
P wave : Sinus P wave present; bear no relationship to QRS;
can be found hidden in QRS complexes and T waves
PR : Varies greatly
QRS : Normal if block in His bundle; wide if block involves bundle
branches
 3rd degree AV block

Usually see complete AV dissociation because the atria and ventricles are
each controlled by separate pacemakers.
Narrow QRS rhythm suggests a junctional escape focus for the ventricles
with block above the pacemaker focus, usually in the AV node.
Wide QRS rhythm suggests a ventricular escape focus (i.e., idioventricular
rhythm).
Thank You