Third-degree AV Block (complete heart block)

Created by team@ekgdx.com on Dec. 21, 2023

Let’s talk about third-degree AV block (complete heart block)

Third-degree AV block (aka complete heart block) is present when the atrial impulses consistenly fail to reach the ventricles resulting in normal atrial rate and slower ventricular rate both indeprendent of each other (complete AV dissociation). 

Criteria

  • PP and RR intervals are regular.
  • Atrial rate is faster than ventricular rate.
  • PR interval varies.
  • P wave may occurs before, within, or after QRS. 
  • AV dissociation must be present (P waves are unrelated to the QRS complexes).

Possible causes: MI, Infiltrative myocardial disease (Amyloidosis, Haemochromatosis, Sarcoidosis), Lenegre’s Disease, Hyperkalemia, Digitalis toxicity, Lyme Disease, Aortic Valve Disease, others.

NOTE: The escape rhythm may arise from the AV node resulting in a narrow QRS complex (unless preexisting BBB), or from subsidiary pacemaker resulting in wide QRS complex.

 

Sinus tachycardia (blue arrows) with AV dissociation (P waves are unrelated to the QRS complexes), consistent with a complete or third-degree AV block.

 

This is a nice example of a complete AV block in the setting of RBBB. What else do you see? More cases available in EKGDX

 

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References

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Dr. Roig

Third-degree AV Block (complete heart block)