Second degree AV block classification: Difference between revisions
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===Type 2 (Mobitz II)=== | ===Type 2 (Mobitz II)=== | ||
*Type 2 second degree AV block, also known as Mobitz II is almost always a disease of the distal conduction system ([[electrical conduction system of the heart|His-Purkinje System]]). | *Type 2 second degree [[AV block]], also known as Mobitz II is almost always a disease of the distal conduction system ([[electrical conduction system of the heart|His-Purkinje System]]). | ||
*Although the terms | *Although the terms intranodal block or infrahisian block are often applied to this disorder, they are not synonymous with it. | ||
:*Infranodal block and [[infra-Hisian block]] are terms | :*Infranodal block and [[infra-Hisian block]] are terms that refer to the anatomic location of the block, whereas, | ||
:*Mobitz II refers to an electrocardiographic pattern associated with block at these levels<ref name="pmid29850368">{{cite journal |vauthors=Li X, Xue Y, Wu H |title=A Case of Atrioventricular Block Potentially Associated with Right Coronary Artery Lesion and Ticagrelor Therapy Mediated by the Increasing Adenosine Plasma Concentration |journal=Case Rep Vasc Med |volume=2018 |issue= |pages=9385017 |date=2018 |pmid=29850368 |pmc=5933017 |doi=10.1155/2018/9385017 |url=}}</ref>. | :*Mobitz II refers to an electrocardiographic pattern associated with block at these levels<ref name="pmid29850368">{{cite journal |vauthors=Li X, Xue Y, Wu H |title=A Case of Atrioventricular Block Potentially Associated with Right Coronary Artery Lesion and Ticagrelor Therapy Mediated by the Increasing Adenosine Plasma Concentration |journal=Case Rep Vasc Med |volume=2018 |issue= |pages=9385017 |date=2018 |pmid=29850368 |pmc=5933017 |doi=10.1155/2018/9385017 |url=}}</ref>. | ||
*Mobitz II heart block is characterized on a surface [[ECG]] by intermittently non-conducted [[P wave]]s not preceded by [[PR prolongation]] and not followed by PR shortening. | * Mobitz II heart block is characterized on a surface [[ECG]] by intermittently non-conducted [[P wave]]s not preceded by [[PR prolongation]] and not followed by PR shortening. | ||
* The medical significance of this type of [[AV block]] is that it may progress rapidly to [[complete heart block]], in which no escape [[rhythm]] may emerge. | |||
* In this case, the person may experience a [[Stokes-Adams attack]], [[cardiac arrest]], or [[sudden cardiac death]]. | |||
* The definitive treatment for this form of [[AV Block]] is an [[implanted pacemaker]]<ref name="pmid29275956">{{cite journal |vauthors=Fu Md J, Bhatta L |title=Lyme carditis: Early occurrence and prolonged recovery |journal=J Electrocardiol |volume=51 |issue=3 |pages=516–518 |date=2018 |pmid=29275956 |doi=10.1016/j.jelectrocard.2017.12.035 |url=}}</ref><ref name="pmid28823599">{{cite journal |vauthors=Tuohy S, Saliba W, Pai M, Tchou P |title=Catheter ablation as a treatment of atrioventricular block |journal=Heart Rhythm |volume=15 |issue=1 |pages=90–96 |date=January 2018 |pmid=28823599 |doi=10.1016/j.hrthm.2017.08.015 |url=}}</ref>. | |||
===Differentiating Mobitz I from Mobitz II in the Presence of a 2:1 Conduction=== | ===Differentiating Mobitz I from Mobitz II in the Presence of a 2:1 Conduction=== | ||
Revision as of 13:26, 8 July 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Salih, M.D., Cafer Zorkun, M.D., Ph.D. [2], Raviteja Guddeti, M.B.B.S. [3]
Overview
There are two distinct types of second degree AV block, called type 1 and type 2. The distinction is made between them because type 1 second degree heart block is considered a more benign entity than type 2 second degree heart block. The distinction between Mobitz I and II can be made only when the ratio of atrial to ventricular conduction is not 2:1, because in 2:1 conduction every other beat is conducted to the ventricle and there is no opportunity to observe the PR prolongation that defines type I and II second degree AV block.
Classification
| Term | Classification | Definition | |
|---|---|---|---|
| Atrioventricular block | First-degree atrioventricular block |
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| Second- degree atrioventricular block |
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| Third-degree atrioventricular block (complete heart block) |
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Type 1 (Mobitz I / Wenckebach)
- Type 1 second degree AV block, also known as Mobitz I or Wenckebach periodicity, is almost always a disease of the AV node[2][3].
- Mobitz I heart block is characterized by progressive prolongation of the PR interval on the electrocardiogram (EKG) on consecutive beats followed by a blocked P wave (i.e. a 'dropped' QRS complex). After the dropped QRS complex, the PR interval resets and the cycle repeats.
- One of the baseline assumptions when determining if an individual has Mobitz I heart block is that the atrial rhythm has to be regular. If the atrial rhythm is not regular, there could be alternative explanations as to why certain P waves do not conduct to the ventricles.
- This is almost always a benign condition for which no specific treatment is needed.
Type 2 (Mobitz II)
- Type 2 second degree AV block, also known as Mobitz II is almost always a disease of the distal conduction system (His-Purkinje System).
- Although the terms intranodal block or infrahisian block are often applied to this disorder, they are not synonymous with it.
- Infranodal block and infra-Hisian block are terms that refer to the anatomic location of the block, whereas,
- Mobitz II refers to an electrocardiographic pattern associated with block at these levels[4].
- Mobitz II heart block is characterized on a surface ECG by intermittently non-conducted P waves not preceded by PR prolongation and not followed by PR shortening.
- The medical significance of this type of AV block is that it may progress rapidly to complete heart block, in which no escape rhythm may emerge.
- In this case, the person may experience a Stokes-Adams attack, cardiac arrest, or sudden cardiac death.
- The definitive treatment for this form of AV Block is an implanted pacemaker[5][6].
Differentiating Mobitz I from Mobitz II in the Presence of a 2:1 Conduction
Likely EKG findings that help differentiate Mobitz type I from type II in the presence of a 2:1 conduction ratio include:
- Very long PR interval (> 300 msec) or narrow QRS complex - indicates the block is at the level of AV node
- Administration of atropine enhances AV nodal conduction resulting in less frequent non conducted beats - this confirms the type I Mobitz
- Mobitz I is worsened by carotid sinus massage which slows AV nodal conduction, unlike Mobitz II.
- Carotid sinus massage paradoxically eliminates [[infranodal block] by slowing the sinus rate[7].
- Another type of classification used to classify second-degree AV block is 2:1 AV block and high-grade block.
- In 2:1 AV block every other atrial impulse is conducted down the ventricle.
- Higher grade blocks (eg., 3:1) unlike third degree AV block conduct few beats down the ventricle.
References
- ↑ Kusumoto, Fred M.; Schoenfeld, Mark H.; Barrett, Coletta; Edgerton, James R.; Ellenbogen, Kenneth A.; Gold, Michael R.; Goldschlager, Nora F.; Hamilton, Robert M.; Joglar, José A.; Kim, Robert J.; Lee, Richard; Marine, Joseph E.; McLeod, Christopher J.; Oken, Keith R.; Patton, Kristen K.; Pellegrini, Cara N.; Selzman, Kimberly A.; Thompson, Annemarie; Varosy, Paul D. (2019). "2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society". Circulation. 140 (8). doi:10.1161/CIR.0000000000000628. ISSN 0009-7322.
- ↑ Mangi MA, Jones WM, Napier L. PMID 29493981. Missing or empty
|title=(help) - ↑ Kashou AH, Goyal A, Nguyen T, Chhabra L. PMID 29083636. Missing or empty
|title=(help) - ↑ Li X, Xue Y, Wu H (2018). "A Case of Atrioventricular Block Potentially Associated with Right Coronary Artery Lesion and Ticagrelor Therapy Mediated by the Increasing Adenosine Plasma Concentration". Case Rep Vasc Med. 2018: 9385017. doi:10.1155/2018/9385017. PMC 5933017. PMID 29850368.
- ↑ Fu Md J, Bhatta L (2018). "Lyme carditis: Early occurrence and prolonged recovery". J Electrocardiol. 51 (3): 516–518. doi:10.1016/j.jelectrocard.2017.12.035. PMID 29275956.
- ↑ Tuohy S, Saliba W, Pai M, Tchou P (January 2018). "Catheter ablation as a treatment of atrioventricular block". Heart Rhythm. 15 (1): 90–96. doi:10.1016/j.hrthm.2017.08.015. PMID 28823599.
- ↑ Schernthaner C, Kraus J, Danmayr F, Hammerer M, Schneider J, Hoppe UC, Strohmer B (March 2016). "Short-term pacemaker dependency after transcatheter aortic valve implantation". Wien. Klin. Wochenschr. 128 (5–6): 198–203. doi:10.1007/s00508-015-0906-4. PMID 26745972.