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ECG library

Third-degree (complete) AV block

advanced

An 81-year-old with syncope on the stairs.

25 mm/s · 10 mm/mV · synthetic tracing
100%
IIIIIIaVRaVLaVFV1V2V3V4V5V6
II (rhythm)
Calipers:2000 ms50.0 small boxes30 bpm if R-RDrag the orange markers. One small box = 40 ms.

Key findings

  • More Ps than QRSs
  • No fixed PR
  • Slow wide escape rhythm

Learning points

  • Map every P with calipers; complete block reveals itself when Ps keep perfect time and ignore the QRS.
  • The width of the escape estimates its origin: narrow junctional escapes are more stable than wide ventricular ones.

Connected