Conduction Disturbances:
Atrioventricular Blocks
Chapter 8
Slide lecture content prepared
by M. Allison Williams, PhD
Introduction
• Some disturbance or blockage within AV node
or bundle of His delays or prevents cardiac
impulse from getting to bundle branches
• partial block
• first degree
• second degree (type I and type II)
• complete block
No coordination between atrium ventricle
• third-degree
C O
P wave 3 5 small boxes 2 seconds
First-Degree AV Block
Always has p wave for each QRS
• Sinus rhythm with PR interval > 0.20 sec and
consistent within each cardiac cycle
– 1 P wave for every QRS complex
– HR can be w/i normal limits, bradycardic or tachycardic
– shape of P wave normal unless atrial enlargement
Prolonged PR interval AV block
Benign monitor
First-Degree AV Block (cont’d)
• Most common causes:
– Enhanced parasympathetic tone
– AV nodal disease
– Coronary artery disease (RCA)
– Medications
– Electrolyte disturbances
• Treatment
– benign rhythm generally
requires no treatment; progression to a higher level
block possible
– in presence of marked bradycardia, atropine to
elevate HR
worry only if it
caused severe bradycardia Ie
Second-Degree AV Block Type I
Non conducted P wave didn't go through Av node
• Also called Mobitz I or Wenckebach phenomenon
– 1 dropped beat, nonconductive P wave, no sinus
rhythm
– PR intervals progressively increase until a P wave
appears without a QRS complex
– Generally, 3-5 beat run of progressing PR intervals
precede nonconducted beat; repeat same pattern
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1
Second-Degree AV Block Type I (cont’d)
• Most common causes:
– Medications
– Ischemia of right coronary artery
– Enhanced vagal tone
– Acute Inferior wall myocardial
infarction
• Treatment
– Usually asymptomatic, benign
rhythm; no treatment necessary
– Progression to a higher-level
block possible.
– Atropine if symptomatic
bradycardia
Veryserious
Second-Degree AV Block Type II
• Type II or Mobitz II typically occurs below the
AV node distal to bundle of His
• Irregular ventricular rate or regular
bradycardic ventricular rate
• Often undiagnosed or misdiagnosed
• Can be life threatening
depolarization Output
Effticular Cardiac
Second-Degree AV Block Type II (cont’d)
No P wave
• Also called Mobitz II prolongation
– Intermittent nonconducted P waves without
progressive prolongation of PR interval
– dropped QRS complexes
– irregular R-R interval
– Regular nonconducted P waves, regular R-R interval
Will always have arrhythmia w/ type I/II not
first degree
Figure 8-4 Mobitz II with a 3:1 Block
Notice that there are three P waves for each QRS complex and the
PR intervals are all consistent.
Second-Degree AV Block
Type II (cont’d)
• Likely caused by structural impairment of
conduction system
– Anteroseptal myocardial infarction
– Fibrosis of the conduction system
– Traditional cardioactive medications
• Treatment
– Pacemaker
ventricles control
themselves
Third-Degree AV Block
• Also called complete heart block (CHB).
– complete absence of conduction through AV junction
• Atria & ventricles depolarize independently
– atria & ventricle “beat to their own drum”
independent of each other
• SA node depolarizes atria; escape pacemaker
below AV junction depolarizes ventricles at slower
rate than atrial contraction
some sightal E
Sare Mding
Third-Degree AV Block (cont’d)
if ventricle is control
• P-P intervals are constant (atrial rate).
themselves QRS would
• R-R intervals are constant (ventricular rate). be very larg
• No consistent PR intervals.
• QRS complex normal width or wide.
Figure 8-5 Third-Degree AV Block causes severe
bradycardia
Regular atrial rate and regular ventricular rate with the atrial rate greater than the
ventricular rate. Because the atrial rate is constant, P waves are buried in the first
and fourth T waves. No consistent PR intervals.
Third-Degree AV Block (cont’d)
• Causes
• Enhanced vagal tone unlikely to cause this level
• Toxicity of cardioactive medications may lead to
temporary and reversible complete heart block
• Acute myocardial infarction
Third-Degree AV Block (cont’d)
• Treatment addresses diminished cardiac
output
– (Temporary) pacemaker
– Withdrawal of medications causing drug-
induced complete heart block
– vagolytic agents such as atropine
bradycardia
always address
almost always treated w pacemaker unless
caused by medications
misusing
2nd degree type 2
3rd degree
Type 1
2nd degree type 1