Atrioventricular

Blocks

Atrioventricular Blocks

AV blocks are delays or

failure of one, some, or all
sinus impulses to travel
through the AV pathway to
the ventricles.

The primary consideration

in managing any of the AV
blocks is the ventricular
rate.

The AV path can be

blocked at several
points: lower atrial
tissue, AV node, His
bundle.

The result is a
prolonged PR
interval or nonconducted P waves.

Classifying Blocks

AV blocks are classified as

incomplete (partial) or
complete blocks.
Incomplete blocks are divided into
first or second degree.

First Degree Block

In first degree block, none of the

impulses are blocked, only
delayed.

First-Degree AV Block

Fig. 36-16A

Copyright 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.

Second Degree Blocks

In second degree blocks, one or
more of the impulses (p waves)
are blocked.
Second degree blocks are further
divided into two types.

Second Degree
Type I ( Mobitz Type I,
Wenckebach)
Type II (Mobitz Type II)

Second Degree AV
Block
Mobitz Type I

Rate
depends on AV conduction
ratio, may be
less than 60
Rhythm
irregular
P wave
normal, some P waves are
not followed by a
QRS
(conduction ratios
are
3:2, 4:3, 5:4 etc. )
PRI
progressively lengthens
until one p wave is not
conducted
(missing
QRS)
QRS
normal

Second-Degree AV Block,
Type 1 (Mobitz I, Wenckebach)

Fig. 36-16B

Copyright 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.

Second Degree AV
Block
Mobitz Type II

Rate
depends on AV conduction
ratio, usually
the rate is less
than 60
Rhythm
irregular
P wave
normal, some P waves are
not followed by a
QRS
(conduction
ratios are
2:1, 3:1, 4:1 etc. )
PRI
may be normal or
prolonged: constant
before the conducted
beats.
QRS
may be normal or greater than
.12 seconds

Second-Degree AV Block,
Type 2 (Mobitz II)

Fig. 36-16C

Copyright 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.

Complete Heart Block

Complete block is referred to as

third degree AV Bock or as AV
dissociation. No impulses are
conducted from atrium to
ventricle. The atria and ventricles
work independently of each other.
An escape rhythm (junctional or
ventricular) paces the ventricle.

Third Degree AV Block

(AV Disociation)

Rate
Ventricular rate will
depend on the
escape pacemaker
Rhythm
regular
P wave
normal but no
relationship between the
P
waves and QRS
PRI
None (none of the
waves are
conducted)
QRS
may be normal or
greater than .12
seconds

Third-Degree AV Heart
Block
(Complete Heart Block)

Fig. 36-16 D
Copyright 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.