AV Nodal Blocks

Lancashire & South Cumbria Cardiac Network

AV Node
AV nodal conduction time is represented
on the ECG as the PR segment.

But - we always measure the PR interval.

AV Nodal Blocks (heart blocks)

Disturbances of the conduction through
the heart, occurring at the AV Node
AV Node damaged/diseased delay or
total block of impulses at the AV Node
This conduction defect can be seen on the
ECG

Causes
Increased vagal tone (parasympathetic
nervous system)
IHD (MI)
Endocarditis
Degeneration (age)
Sclerosis (Aortic)
Cardiac surgery trauma

First Degree Heart Block (1)

SA Node normal
Normal P wave

AV Node conducts more slowly than

normal
Prolonged PR Interval

Rest of conduction is normal

Normal QRS

First Degree Heart Block (1)

PR Interval > 0.2 seconds (5 small sq)

Note the PR Interval is constant

Clinical significance
None

Treatment
None

Note this can progress to 2 or 3 heart

block

Second Degree Heart Block (2)

Mobitz Type I (Wenkebach)

Mobitz Type II
2:1

Second Degree Heart Block (2)

Mobitz Type I
(Wenkebach)

Conduction through the AV Node

progressively delayed until a drop beat is
seen

Second Degree Heart Block (2)

Mobitz Type I
(Wenkebach)

PR

PR

PR

DROPPED BEAT

Second Degree Heart Block (2)

Mobitz Type I
(Wenkebach)
PR Interval prolongs with each beat until a
dropped beat is seen
The PR Interval is NOT constant
After each dropped beat, the PR interval is
normal and the cycle starts again

Clinical Significance
Slight symptoms eg. Lethargy,Confusion

Treatment
Pacemaker if during day &/or symptoms
No treatment if at night

Note this can progress to 3 Heart Block

Second Degree Heart Block (2)

Mobitz Type II

Conduction through the AV node is

constant but dropped beats are seen

Second Degree Heart Block (2)

Mobitz Type II

PR

PR

DROPPED BEAT

PR

Second Degree Heart Block (2)

Mobitz Type II

PR Interval normal & constant

Occasionally a dropped beat is seen

Clinical significance this is more

significant disease
Treatment pacemaker
Note this can progress to 3 Heart Block

Second Degree Heart Block (2)

2:1
Unable to strictly classify as Mobitz Type I
or II
Particular type of second degree Heart
Block
Ratio 2 P waves : 1 QRS

Second Degree Heart Block (2)

2:1

Clinical significance unable to classify as

Mobitz type I or II
Will be associated with symptoms, dizziness,
lethargy etc.

Treatment pacemaker
Note this can deteriorate to 3 Heart
Block

Third Degree Heart Block (3)

(Complete)
Complete failure of the AV Node
No impulses from Sinus Node will pass
through to the ventricles
Some part if the conducting system will
take over as pacemaker of the heart (even
a myocardial cell 10-15 bpm)

Third Degree Heart Block (3)

(Complete)
P wave rate normal
Ventricular rate slow
Ventricular complex may be broad
Idioventricular rhythm

Complete dissociation between P waves &

QRS

Third Degree Heart Block (3)

(Complete)

QRS

QRS

clinical significance
Symptoms LOC, Confusion, Dizziness, Low
BP
Can lead to standstill, VT or VF (stokes
Adams)

Treatment - pacemaker

Summary
1 - prolongation of PR Interval
2 - Mobitz I Increasing PR Interval until
dropped beat is seen
Mobitz II Constant PR Interval with
more P waves to QRS
2 : 1 Constant PR Interval with more
P waves to QRS
3 - Complete dissociation between P
waves & QRS