ECG-AV block, 2nd Degree, Mobitz type 2

60 year old female comes to JIPMER, Pondicherry, India hospital emergency department with chief complaints of giddiness since last two months. There was no history of chest pain, perspiration, or syncope.During examination in the emergency department patient pulse rate was around 84 beats per minutes, BP-110/80 mmhg. ECG done in the emergency department is shown  below.

ECG-1

Sinus rhythm at 100 beats per minute, PR interval 120 msec, broad QRS complex, QRS duration 120 msec, normal axis, QT interval 400 msec, QTc  516 msec, ecg is showing variable conduction, with  initial part showing conduction of three P wave followed by non conducted P wave, rest of the ecg is showing 3:2 AV block, PR interval is constant suggestive of  2 ND degree, Mobitz Type II AV block.

ECG-2

ECG of the same patient showing variable AV block, initially there are four conducted P wave than non conducted P wave, than two conducted P wave and one non conducted P wave, than three conducted P wave followed by one non conducted P wave, QRS is showing LBBB morphology

Diagnosis of the patient-2 nd degree Mobitz Type II AV block

Patient underwent electrophysiology study at JIPMER hospital, Pondicherry and found  to have infrahisian block. Patient underwent successful Pacemaker implantation by Dr Raja Selvaraj and his team (Dr Raja Ramesh).