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ECG of the week#2: what kind of block?

Test yourself with this week’s ECG case. Then scroll down for a structured step-by-step interpretation and clinical pearl.

Clinical Scenario

A 60-year old presented with presyncope.

The final ECG interpretation is 2nd degree AV block with 2:1 conduction. Do you agree?

Heart rate/rhythm: regular wide complex bradycardia with AV dissociation = sinus with 3rd degree AV block and escape rhythm
Electrical conduction: variable PR interval, wide QRS from RBBB
Axis: normal
R-wave progression: early from RBBB
Tall/small voltages: normal
ST/T changes: inferior T wave inversion

3rd degree AV block, needs pacemaker

If there’s an AV block, look at the whole rhythm strip to assess PR interval

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