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Junctional escape rhythm from above the His bundle.An escape pacemaker occurs distal to the block:.Occurs because no atrial impulses reach the ventricles.Atrial activation and ventricular activation are independent of each other.Complete failure of conduction between the atria and ventricles.Can deteriorate into 3rd-degree AV block.Almost always results from conduction system disease below the level of the AV node.Intermittent block of conduction through the AV node → unchanged PR intervals with intermittent QRS complexes “dropped”.Usually the result of excess vagal tone of the AV node in athletes.Progressive increase in the delay of conduction until a block forms at the AV node → conduction is not transmitted through the AV node → the QRS complex is “dropped”.Mobitz type 1 (also known as “Wenckebach”):.Second-degree AV block is further divided into 2 subtypes: Defined as a prolonged PR interval (> 0.2 sec).Delayed or prolonged conduction through the AV node not considered a true block.Infrahisian (below the His bundle) blocks result in wide QRS complexes. Blocks at the level of the AV node or the His bundle will generally be narrow. Atrioventricular block may occur within the AV node, His bundle, or the bundle branches. Schematic of the electrical system of the heart. Antiarrhythmics (amiodarone, quinidine, procainamide, disopyramide).Non-dihydropyridine calcium channel blockers.Increased vagal tone (due to athletic training, sleep, pain, carotid sinus massage, carotid sinus hypersensitivity syndrome).
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Other bacterial, viral, and parasitic causes.Hypertrophic obstructive cardiomyopathy.
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