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This post is an answer to the ECG Case 330

• Rate:
  • Mean atrial rate 100 bpm
  • Mean ventricular rate 35 bpm
• Rhythm:
  • Regular atrial and ventricular activity
  • AV dissociation
  • Atrial rate greater than ventricular rate

• Axis: Right axis deviation
• Intervals: QRS – Prolonged (140ms)
• Additional:
  • Subtle ST elevation in leads aVR and aVL
  • Subtle ST depression in leads II, aVF, V2-4
  • Distortion of QRS complexes due to superimposed P waves 

Interpretation

• Complete heart block

The majority of complete heart block we see is idiopathic in origin but consideration needs to be made as to potential underlying and more importantly reversible causes including:

• ACS
• Drug toxicity
• Hypothermia
• Inflammatory – myocarditis
• Infiltrative disease – sarcoid etc.

What happened next ?

There were no identifiable reversible causes and the patient was admitted for an uneventful PPM insertion.

READ MORE: Conduction Blocks at the AV Node (AV Blocks) [With Examples]

SIMILAR CASES:

• Complete (third degree) Heart Block in 80-year-old woman
• First, Second and Third Degree AV Block in the Same Patient
• Third-degree AV Block then Second-degree AV block