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AV block Idioventricular escape rhythm

ECG Basics: Third-degree AV Block, Complete Heart Block

Wed, 11/18/2015 - 12:31 -- Dawn

This rhythm strip shows third-degree AV block, also called complete heart block or complete AV block.  The P waves are from the sinus node, and are regular at a rate of about 120/min. (Sinus tachycardia). This is a good strip for showing your students how to "march out" the P waves to find the ones that are hidden behind QRS complexes or T waves. Knowing that the P waves are regular, it is easy to find the hidden ones.

The QRS complexes are wide at 0.14 seconds, and regular, with a rate of about 28/min.  On first glance, it APPEARS that there are PR intervals.  That is, it appears that some of the P waves are conducting. If you measure the PR intervals carefully, you will note that they are NOT equal.  There is no connection between the P waves and the QRS complexes - this strip has just caught them near each other.  If we ran the strip longer, we would see the PR intervals "come apart", proving they are not real.  The QRS complexes are coming from an IDIOVENTRICULAR ESCAPE RHYTHM.  They are regular, wide, have no P waves associated with them, and the rate is below 40 bpm.

Patients with CHB that results in a very slow heart rate sometimes need emergency treatment aimed at increasing the rate.  When the escape rhythm is idioventricular, it is assumed that the AV block is located below the AV node, and emergency temporary pacing is often the method of choice.  In fact, a permanent implanted pacemaker is almost always needed.  When the AV block is located in the AV node, the escape rhythm will be junctional (narrow QRS complexes, rate about 40-60 bpm).     

 

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