Second degree AV block classification: Difference between revisions
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*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]]. | *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]]. | ||
===Differentiating Mobitz I from Mobitz II in the Presence of 2:1 Conduction=== | ===Differentiating Mobitz I from Mobitz II in the Presence of a 2:1 Conduction=== | ||
Likely EKG findings that help differentiate Mobitz I from II in the presence of a 2:1 conduction ratio include: | Likely EKG findings that help differentiate Mobitz I from 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 | * 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 nonconducted beats - this confirms type I Mobitz | * Administration of [[atropine]] enhances AV nodal conduction resulting in less frequent nonconducted beats - this confirms 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. | |||
* 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. | |||
==References== | ==References== | ||
Revision as of 18:00, 12 February 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]
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
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.
- 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 infranodal block or infrahisian block are often applied to this disorder, they are not synonymous with it.
- Infranodal block and infra-Hisian block are terms which refer to the anatomic location of the block, whereas
- Mobitz II refers to an electrocardiographic pattern associated with block at these levels.
- 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.
Differentiating Mobitz I from Mobitz II in the Presence of a 2:1 Conduction
Likely EKG findings that help differentiate Mobitz I from 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 nonconducted beats - this confirms 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.