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 An atrioventricular block (or AV block) involves the
impairment of the conduction between the atria and ventricles
of the heart.

SA node in the atria sets the pace for the heart, and these
impulses travel down to the ventricles. In an AV block, this
message does not reach the ventricles or is impaired along the
way.

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🞂 ​ Congenital defect

🞂​ MI

🞂 ​ Myocarditis or cardiomyopathy

🞂 ​ Heart surgery

🞂 ​ Digoxin over dose

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🞂​ Types
◦ Ist degree
◦ 2nd degree
◦ 3rd degree
◦ Bundle branch block ( Rt & Lt)

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First Degree Heart Block:

🞂 ​ All impulses reach the ventricles. Delay occurs in

🞂 ​ Rate: normal or Bradycardia

🞂 ​ No
hemodynamic consequences, and produces no
symptoms

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🞂​ This disturbance occurs when conduction
in the AV node slows so that the PR
interval is longer than .20 seconds.

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🞂 ​ If stable – no treatment
🞂 ​ If block getting longer –notify physician

🞂 ​ If block due to drug therapy – notify physician

🞂 ​ When associated with symptomatic bradycardia,

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Second Degree Heart Block:
Morbitz type I (Wenckebach)

🞂 ​ Block is in AV node
🞂 ​ ECG shows a gradual lengthening of the PR interval, and a QRS
complex is then missed
🞂 ​ Rate: Usually slow 50/min or may be normal
🞂 ​ Usually asymptomatic.
Management
If symptomatic, can administer atropine and oxygen. If
no response temporary pacemaker required.

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🞂​ This is composed of recurrent cycle in
which the PR interval become progressive
prolong until eventually no QRS complex
follows the P wave.

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In this block PR intervals remain constant in
length although they may be normal or slightly
prolonged.
The P wave are normal and are followed by
normal QRS complexes at regular intervals until
suddenly a ventricular wave is dropped.

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Morbitz type II (2 Degree)

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2:1 Second Degree Heart Block:

🞂 ​ Every second P wave is conducted to the

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2:1 Second Degree Heart Block:

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Morbitz I is usually due to a functional suppression of
AV conduction (e.g. due to drugs, reversible ischemia),

Morbitz II is more likely to be due to structural damage

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Third Degree Heart Block:
🞂 ​ The ventricular rate is between 30-50/minute
🞂 ​ SOME TIME QRS will be like PVCs
🞂 ​ No relationship between atria and ventricles can be
found
🞂 ​ None of the sinus impulses conduct to the ventricles
🞂 ​ Manifestations depend on cardiac output
🞂 ​ Predisposes to VT, VF, or asystole

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🞂 ​ Permanent pacemaker required.

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Third Degree Heart Block:

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🞂 ​ Conduction
disturbances of the bundles is referred to as
bundle branch block and is usually of the right or left
bundle.

🞂 ​ Delayed
ventricular conduction resulting in a broad
QRS complex.

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 Any bundle branch is blocked

Impulses travel through the intact branch and stimulate the

Ventricle gets the stimulation from the unaffected branch

Delay in conduction

Wide QRS in ECG

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🞂 ​ Rate: Usually normal
🞂 ​ Rhythm: Regular

🞂 ​ P wave: Normal

🞂 ​ P-R interval: Normal because impulses reach the uninvolved

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Is an electric device that “creates” and “transmits” an electric
signal to the atria, ventricles or both. It works as a generator at
home.

🞂 ​ Temporary PM
🞂 ​ Permanent PM

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🞂 ​ Transcutaneous temporary
pacemaker

🞂 ​ Transvenous temporary pacemaker

🞂​ Epicardial temporary pacemaker

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COMPONENTS:

🞂 ​ Generator

🞂 ​ Pacing catheter/lead
🞂 ​ Heart

MODES:

🞂 ​ Demand

🞂 ​ Fixed

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🞂 ​ Sensing:This enables the pacemaker to see the
intrinsic electrical activity of the heart.

🞂 ​ Firing:
Means that the pulse generator has delivered a
stimulus, which is observed as a ‘spike’ on the ECG, followed
by a wide QRS complex.

🞂 ​ Automatic Interval: Interval b/w consecutive paced events.

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🞂 ​ Output:
The amount of electrical current delivered to the
myocardium by the pulse generator. Measured in milliamperes
(mA).

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🞂 ​ Pain
🞂 ​ Pneumothorax
🞂 ​ Hematoma
🞂 ​ Lead Perforation
🞂 ​ Subcutaneous emphysema
🞂 ​ Air embolism
🞂 ​ Vascular puncture
🞂 ​ Skin erosion
🞂 ​ Pacemaker failure
🞂 ​ Lead dislodgment
🞂 ​ Pacer related arrhythmias
🞂 ​ Infection
🞂 ​ Pacemaker allergy

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🞂 ​ Continuous ECG monitoring
🞂 ​ Properly secure the lead and the external pulse generator
🞂 ​ In temporary pacing inspect the site carefully for
purulent discharge and edema
🞂 ​ Observe for systemic infection
🞂 ​ Perform site care
🞂 ​ If defibrillation required, turn off the TPM and avoid
shock over the PPM
🞂 ​ Teach pt to take his radial pulse and report to ER if HR<
pacer rate

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🞂 ​ Regular follow up to check site and function of
device
🞂 ​ Watch site for signs of infection

🞂 ​ Keep site dry for I week after implant

🞂 ​ Avoid blow to generator site

🞂 ​ Regular monitoring of pulse

🞂 ​ Pacemaker information card

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