8/10/2019 ECG, Block Intraventricular,Preexcitation (Rev)
1/25
Teuku Heriansyah
8/10/2019 ECG, Block Intraventricular,Preexcitation (Rev)
2/25
The Conduction System
8/10/2019 ECG, Block Intraventricular,Preexcitation (Rev)
3/25
Normal Sinus Rhythm
Rhythm : Regular
Rate : 60100
P wave : Normal in configuration; precede each QRS
PR : Normal ( 0. 120.20 seconds )
QRS : Normal ( less than 0.12 seconds )
8/10/2019 ECG, Block Intraventricular,Preexcitation (Rev)
4/25
First-degree AV block
Rhythm : Regular
Rate : Usually normal
P wave : Sinus P wave present; one P wave to each QRS
PR : Prolonged ( greater than 0.20 seconds )QRS : Normal
8/10/2019 ECG, Block Intraventricular,Preexcitation (Rev)
5/25
Second -degree AV block, Mobitz I
Rhythm : Irregular
Rate : Usually slow but can be normal
P wave : Sinus P wave present;
some not followed by QRS complexes
PR : Progressively lengthens
QRS : Normal
8/10/2019 ECG, Block Intraventricular,Preexcitation (Rev)
6/25
Second -degree AV block, Mobitz I
8/10/2019 ECG, Block Intraventricular,Preexcitation (Rev)
7/25
Second-degree AV block, Mobitz II
Rhythm : Regular usually;can be irregular if conduction ratios vary
Rate : Usually slow
P wave : Two, three, or four P waves before each QRS
PR : PR interval of beat with QRS is constant;
PR interval may be normal or prolonged
QRS : Normal if block in His bundle;
wide if block involves bundle branches
8/10/2019 ECG, Block Intraventricular,Preexcitation (Rev)
8/25
Third-degree AV block (Total AV block)
Rhythm : Regular
Rate : 4060 if block in His bundle;3040 if block involves bundle branches
P wave : Sinus P wave present; bear no relationship to QRS;
can be found hidden in QRS complexes and T waves
PR : Varies greatly
QRS : Normal if block in His bundle;
wide if block involves bundle branches
8/10/2019 ECG, Block Intraventricular,Preexcitation (Rev)
9/25
Third-degree AV block (Total AV block)
8/10/2019 ECG, Block Intraventricular,Preexcitation (Rev)
10/25
Second -degree AV block, Mobitz I
8/10/2019 ECG, Block Intraventricular,Preexcitation (Rev)
11/25
Second -degree AV block, Mobitz II
8/10/2019 ECG, Block Intraventricular,Preexcitation (Rev)
12/25
Atrioventricular dissociation secondary to complete heart block
8/10/2019 ECG, Block Intraventricular,Preexcitation (Rev)
13/25
High-grade atrioventricular block
8/10/2019 ECG, Block Intraventricular,Preexcitation (Rev)
14/25
QRS Duration > 0.12 secondsR in Leads aVR and V1
S wave in Leads I and V6 >
0.40 seconds
Normal initial QRS
Right Bundle Branch Block
8/10/2019 ECG, Block Intraventricular,Preexcitation (Rev)
15/25
QRS Duration > 0.12 secondsQ waves absent in Leads I,
V5, V6
Broad notched QRS in Leads
V5, V6 and AVL
Time to R > 0.06 seconds in
wave peak leads V5 and V6
Left Bundle Branch Block
8/10/2019 ECG, Block Intraventricular,Preexcitation (Rev)
16/25
Left BundleBranch Block
8/10/2019 ECG, Block Intraventricular,Preexcitation (Rev)
17/25
Small Q wave in Leads I,
aVL, V5 and V6Small R wave in Leads III
and aVF.
Frontal plane axis of -30o
to -90o
QRS duration < 0.12 sec.
Left Anterior Fascicular Block :
8/10/2019 ECG, Block Intraventricular,Preexcitation (Rev)
18/25
Frontal plane axis of 90o
to 180o
Small R wave in Leads
I and aVL
Tall R wave in Leads II,
III and aVF
Q wave in inferior leads
< 0.04 seconds
Left Posterior Fascicular Block :
8/10/2019 ECG, Block Intraventricular,Preexcitation (Rev)
19/25
Incomplete right bundle branch block
8/10/2019 ECG, Block Intraventricular,Preexcitation (Rev)
20/25
Right bundle branch block
8/10/2019 ECG, Block Intraventricular,Preexcitation (Rev)
21/25
Left bundle branch block
8/10/2019 ECG, Block Intraventricular,Preexcitation (Rev)
22/25
8/10/2019 ECG, Block Intraventricular,Preexcitation (Rev)
23/25
Wolff-Parkinson-White syndrome
8/10/2019 ECG, Block Intraventricular,Preexcitation (Rev)
24/25
Wolff-Parkinson-White syndrome
8/10/2019 ECG, Block Intraventricular,Preexcitation (Rev)
25/25
Thank You