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Submitted by jer5150 on Sun, 01/06/2013 - 19:03

This ECG was taken from an 87-year-old black man and was diagnosed by the reviewing cardiologist as "complete AV block".

Is that really the interpretation or is it something else?

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Submitted by Christopher on Sun, 01/06/2013 - 19:52

...back, back, back, aannd it's outta here!

I imagine that would be the color commentary for this strip if a baseball announcer got ahold of it. Looks like a case of AV Wenckebach with PR-intervals Of Unusual Size (P.R.O.U.S.).

Very neat strip!

Christopher
sixlettervariable.blogspot.com
ems12lead.com

Submitted by Chireu on Mon, 01/07/2013 - 19:41

Seems like simple wenckebach, PRI increase, increase, increase drop beat

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Submitted by chillbee on Sat, 01/12/2013 - 19:43

Wenckebach

Caprice Hill Black

Submitted by langbam91 on Sat, 01/12/2013 - 21:40

wenckeback.

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Submitted by jer5150 on Sun, 01/13/2013 - 09:27

INTERPRETATION:
1.  Sinus bradycardia (rate about 49/min) with . . .
2.  . . . Type I A-V (nodal) block manifest in the form of . . .
3.  . . . Wenckebach periods. 

COMMENTS:
I found this ECG by searching our computer database for the longest P-R intervals I could find.  Here, the shortest P-R interval (0.51s) is longer than the longest P-R interval seen in most of the typical cases of Type I A-V block.  The longest P-R interval reaches a much prolonged length of 0.77s!  On Facebook, one responder simply interpreted this as "A-V dissociation" which is not a diagnosis but rather a secondary finding that is always caused by something else.  I can only imagine that they called it that by not wanting to believe that P-R intervals can attain such great lengths.  Again, here there is no A-V dissociation and all sinus impulses are conducting except for the 5th one.  It's worth emphasizing that the longest P-R interval ever documented in a publication reached a astounding duration of 1.10s!!!  Personally, the longest P-R interval I've ever witnessed, on a patient I was monitoring, was 1.04s!  Note that the cycle encompassing the "dropped" beat is less-than twice the shortest cycle.  The ratio of the Wenckebach periods is probably 5:4. 

Jason E. Roediger - Certified Cardiographic Technician (CCT)
[email protected]

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Submitted by [email protected] on Sun, 01/13/2013 - 12:34

Nice example by Jason illustrating the concept that the PR interval may be very long and still conduct! Nicely drawn laddergram clearly illustrates the KEY features of Wenckebach.

  • Jason - I thought you were going to dig up even longer PR interval than this .... In my faint recollection (unfortunately don't have the tracings) - I thought I remembered Barney Marriott showing examples of PR intervals that still conducted that were well over 1.1 second (so much so, that the PR that conducted was followed by 2 QRS complexes - and conducted to the 2nd one ... ). But your example nicely emphasizes that this definitely is NOT AV dissociation nor complete AV block - but rather (as Chireu says) "simple Wenckebach".
  • Of note - there is underlying sinus bradycardia and abnormally peaked T waves in the anterior precordial leads (V1,2,3) - which given the 2nd degree AV block, Mobitz Type 1 suggest to me the likelihood of posterior ischemia.

THANKS for showing this interesting example of Wenckebach - : )

Ken Grauer, MD  www.kg-ekgpress.com   [email protected] 

Submitted by mjross on Sun, 01/13/2013 - 15:06

It initially appeared to be Wenckebach to me (type I) with P-P is consistency and P-R interval lengthens until the drop (ker-plop) occurs.  That is an extremely long P-R.  I wonder the reasoning of the CHB conclusion (?).  I'm glad to read the other comments to confirm the 2 degree.

Thanks for the research and great example.    

I'm a newbie - a little lost but anxious to learn my way around  8)

Mary Jane Ross CCT

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