Thursday, June 29, 2017

Wenckebach, or type I second-degree AV block

A 62-year-old man with coronary artery disease (CAD) presents with presyncope. His physical examination is normal except for bradycardia (pulse 56 beats/min) and an irregular pulse. The electrocardiogram (ECG) shows Wenckebach’s type atrioventricular (AV) block.

Which of the following are you most likely to see on the ECG?
(A) progressive PR shortening
(B) progressive lengthening of the PR interval
(C) tachycardia
(D) dropped beat after PR lengthening
(E) fixed 2:1 block

Answer: (D) dropped beat after PR lengthening



Discussion:
Wenckebach, or type I second-degree AV block, is characterized on ECG by progressive
lengthening of the PR interval until there is a non conducted P wave. The magnitude of PR lengthening declines with each beat, so the RR intervals characteristically shorten prior to the dropped beat. It is almost always caused by abnormal conduction across the AV node, and the QRS complex is usually of normal duration.
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6 comments:

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  3. Blue MoonOctober 18, 2019 at 6:55 PM

    We need a longer strip I think. I agree there is progressive PR lengthening but the 4th P wave is non-existant with no evidence of it buried in the T wave. Each cycle lengthens by 80ms so we should see the P. I think there could be wencheback AV block plus a mobitz 2 sinoatrial exit block here, but need a full 12 lead to confirm.

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