(Image 1) Why is there no second-degree AVB Mobitz type II and no high-grade AV block? To the first question: Basically, second-degree AV block Mobitz type II is rare. The two ECG patterns that can easily be confused with Type II Mobitz block are: blocked/non-conducted PACs and second-degree AVB Mobitz type I (Wenckebach). (Image 2) You have to compare the PR duration before the pause and after it. With the naked eye, the difference is often difficult to recognize, a pair of calipers does a good job here.
Why is this left atrial atypical atrial flutter (ECG 1)? Atrial fibrillation can be excluded because nice flutter waves (all look the same) can be clearly identified. With typical right atrial flutter, the reentry circle runs counterclockwise and we see typical saw tooth patterns in the inferior leads (negative flutter waves). The flutter waves are positive in V1 (ECG 2). With typical right atrial flutter with a clockwise reentry circle, the flutter waves in the inferior leads are positive.
This ECG comes from a 75 yo man who had 2 syncopes in the past few weeks. The 12-lead-EKG at the family doctor showed an inconspicuous finding. Here you can see a section of the patients Holter ECG. There is a very slow junctional escape rhythm. How can this be recognized?
This Holter-ECG comes from a 70-year-old physician with coronary artery disease. He is twelve months after PCI (RCA, RCX). Currently no symptoms (no dyspnea, no chestpain, no palpitations). You can see that an overview/section from a Holter- EKG, 3 channels are shown, strip width is 30 seconds. First you can see a sinus rhythm with frequent PVCs, then there is a transition to an accelerated idioventricular rhythm (AIVR) that lasts almost a minute in total.
This ECG is from an 80-year-old lady who has collapsed or had sycopal episodes several times. The ECG comes from a Holter monitor. She has arterial hypertension and coronary artery disease. The ECG shows a second-degree, Mobitz Type II AV block. In both types of AVB, the PP intervals are usually the same.
Here is the EKG of a 54 -year -old woman without known cardiac disease. The EKG was routinely carried out before a surgical intervention. It`s a screenshot. You can see a normal SR with narrow QRS, followed by an incompete LBBB and then a complete LBBB. A LBBB is often associated with cardiac diseases, but it also occurs without a heart disease.