Teuku Heriansyah

The Conduction System

Normal Sinus Rhythm

Rhythm : Regular Rate PR QRS : 60 100 : Normal ( 0. 12 0.20 seconds ) : Normal ( less than 0.12 seconds )

P wave : Normal in configuration; precede each QRS

First-degree AV block
Rhythm : Regular

Rate
PR

: Usually normal
: Prolonged ( greater than 0.20 seconds )

P wave : Sinus P wave present; one P wave to each QRS

QRS

: Normal

Second -degree AV block, Mobitz I

Rhythm : Irregular

Rate

: Usually slow but can be normal

some not followed by QRS complexes

P wave : Sinus P wave present;

PR
QRS

: Progressively lengthens
: Normal

Second -degree AV block, Mobitz I

Second-degree AV block, Mobitz II

Rhythm : Regular usually; can be irregular if conduction ratios vary Rate PR QRS : Usually slow : PR interval of beat with QRS is constant; PR interval may be normal or prolonged : Normal if block in His bundle; wide if block involves bundle branches P wave : Two, three, or four P waves before each QRS

Third-degree AV block (Total AV block)

Rhythm : Regular Rate : 40 60 if block in His bundle; 30 40 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

Third-degree AV block (Total AV block)

Second -degree AV block, Mobitz I

Second -degree AV block, Mobitz II

Atrioventricular dissociation secondary to complete heart block

High-grade atrioventricular block

Right Bundle Branch Block

QRS Duration > 0.12 seconds R in Leads aVR and V1 S wave in Leads I and V6 > 0.40 seconds Normal initial QRS

Left Bundle Branch Block

QRS Duration > 0.12 seconds Q 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

Left Anterior Fascicular Block :

Small Q wave in Leads I, aVL, V5 and V6 Small R wave in Leads III

and aVF.
Frontal plane axis of -30o to -90o

QRS duration < 0.12 sec.

Left Posterior Fascicular Block :

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

Incomplete right bundle branch block

Right bundle branch block

Left bundle branch block

Wolff-Parkinson-White syndrome

Wolff-Parkinson-White syndrome

Thank You