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23-16: Type 2 Second-Degree AV Block (Mobitz II)

Maite A. Huis in ‘t Veld; Amal Mattu; R. Jason Thurman

ECG Findings

  • Intermittent nonconducted P waves with a constant PR interval.

  • P-P interval is constant, and R-R interval is constant until the dropped beat.

  • R-R interval surrounding dropped beat(s) should be an exact multiplication of the number of dropped beats (eg, double RR interval for a single dropped beat, four times the RR interval for two dropped beats, etc.).

Pearls

  1. This type of AV nodal block is associated with disease of the conduction system distal to the AV node. A pacemaker is usually indicated.

  2. Mobitz type II block can accompany MI and has a high chance of progression to a complete heart block.

FIGURE 23.16A

Type II Second-Degree AV Block (Mobitz II). (ECG contributor: Michael L. Juliano, MD.)

An E C G with 12 leads from a patient with type 2 second-degree A V block.
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FIGURE 23.16B

The PR interval is constant (double arrows) until the dropped beat (brackets).

An E C G tracing with one lead consists of a curved dip, a small, sharp peak, and a square peak. Double-headed arrows are between the curved dip and the sharp peak. A pair of square brackets encloses a region near the flatline.
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