High-gradeĀ AV Block
Let’s talk about high-grade AV block.
High-grade AV block is a form of second-degree (incomplete) AV block that is often mistaken for third-degree (complete) AV block. This condition manifests when two or more consecutive P waves are blocked. This disruption in conduction poses a significant risk as it may advance to complete heart block. The affected anatomical region is typically below the AV node, resembling Mobitz type 2. The P:QRS ratio is 3:1 or higher, and the ventricular rate tends to be markedly slow. What distinguishes high-grade AV block from third-degree heart block is the persistence of some relationship between P waves and QRS complexes. In other words, there is still some AV conduction taking place.
Criteria
- P:QRS ratio is 3:1 or higher.
- PR interval is constant in the conducted beats.
This is a nice example of high-grade AV block in the setting of RBBB. Note the constant PR interval in the conducted beats with a P:QRS ratio of 3:1. What else do you see? More cases available in EKGDX.
Same case with graphic explanation.
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