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Challenges in Clinical Electrocardiography
Mar 11, 2013

Atrioventricular Block With 2:1 Conduction—Discussion

Author Affiliations
 

SECTION EDITORS: JEFFREY TABAS, MD; PAUL D. VAROSY, MD; GREGORY M. MARCUS, MD; NORA GOLDSCHLAGER, MD

JAMA Intern Med. 2013;173(5):336-337. doi:10.1001/jamainternmed.2013.3182b

The patient was admitted to the hospital for intravenous diuretics, supplemental oxygen, and telemetry monitoring. Despite improved hypoxia, her weakness and light-headedness continued. The ECG demonstrated second-degree atrioventricular (AV) block (AVB) with 2:1 conduction, a normal P-R interval, and widened QRS complex suggestive of an infranodal block. Owing to the patient's symptoms and suspected block location, ambulation to evaluate the response to an increased sinus rate and enhanced AV nodal conduction was considered to be not clinically advisable. The patient was asked to perform a Valsalva maneuver to further support the diagnosis (Figure 2). A reversible cause of AVB was not identified on detailed medical history and laboratory evaluation. Because of persistent symptoms, an electrophysiologic study to definitively localize the block was not indicated, and she underwent implantation of a dual-chamber pacemaker with symptom resolution shortly thereafter.

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