Second degree AV block classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

There are two distinct types of second degree AV block, called type 1 and type 2. The distinction is made between them because type 1 second degree heart block is considered a more benign entity than type 2 second degree heart block.

Classification

Type 1 (Mobitz I / Wenckebach)

  • Type 1 Second degree AV block, also known as Mobitz I or Wenckebach periodicity, is almost always a disease of the AV node.
  • Mobitz I heart block is characterized by progressive prolongation of the PR interval on the electrocardiogram (EKG) on consecutive beats followed by a blocked P wave (i.e. a 'dropped' QRS complex). After the dropped QRS complex, the PR interval resets and the cycle repeats.
  • One of the baseline assumptions when determining if an individual has Mobitz I heart block is that the atrial rhythm has to be regular. If the atrial rhythm is not regular, there could be alternative explanations as to why certain P waves do not conduct to the ventricles.
  • This is almost always a benign condition for which no specific treatment is needed.

Type 2 (Mobitz II)

  • Type 2 Second degree AV block, also known as Mobitz II is almost always a disease of the distal conduction system (His-Purkinje System).
  • Although the terms infranodal block or infrahisian block are often applied to this disorder, they are not synonymous with it.
  • Infranodal block and infrahisian block are terms which refer to the anatomic location of the block, whereas
  • Mobitz II refers to an electrocardiographic pattern associated with block at these levels.

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