Conduction disorders

(heart blocks)
created by PhD, Assistant of the Department of Internal medicine №2,
Clinical Immunology and Allergology named after academician L.T.Malaya
Tetiana Zaikina
 Conduction system

S
 Heart blocks
• Sinoatrial block
• Atrioventricular block
• Bundle branch block
• Fascicular block
 Sinoatrial block

Normal sinoatrial conduction

First-degree SA block
 Sinoatrial block
Second-degree SA block, type 1

Second-degree SA block, type 2

Third-degree SA block
 AV blocks
First-degree AV block
R R
P

PR>0,2 sec

Second-degree AV block, Mobitz type 1

P-wave is
blocked
 AV blocks
Second-degree AV block, Mobitz type 2

P-wave
is
blocked

Third-degree AV block (complete AV block)

R

P
 P

Speed 25 mm/sec
P
P
 PR R TP R
P
 Intraventricular block (bundle branch
block)

• Widened QRS complex

≥0,12 sec

• Altered QRS
morphology (M-like
shape)

• Altered electrical axis

RBBB vs LBBB
 Fascicular block
Left anterior fascicular block Left posterior fascicular block

• Widened QRS 0,1-0,11 sec • Widened QRS 0,1-0,11 sec

• Left axis deviation • Right axis deviation
Speed 25 mm/sec
 Cardiac pacing
is mandatory in the case of
• symptomatic sinus node disease
with pauses˃3 sec
• AV block of II (Mobitz type 2) and
III degrees
• pause-dependent VT (in long QT-
syndrome)
• reccurrent syncope caused by
spontaneously occurring carotid
sinus stimulation and when
carotid sinus pressure induces
ventricular asystole ˃3 sec
International coding of pacemakers
1st letter: is the paced chamber (A-atrium, V-
ventricle, D-dual)
2nd letter: is the sensed chamber (A-atrium, V-
ventricle, D-dual)
3rd letter: operation type (I-inhibition, T-
triggering, D-dual, O-nothing)
4th letter: frequency adaptation (R-rate
modulation)
The most popular are DDD or AAI mode
 Types of cardiac pacing
Atrial

Ventricular

Dual (atrial+ventricular)