Arrhythmia Recognition: The Art of Interpretation
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Practice Rhythm Strips

Practice Rhythm Strip 12
 
Rate:About 60 BPMPR intervals:Variable
Regularity:Regularly irregularQRS width:Normal
P waves:Normal Grouping:Present
   Morphology:NormalDropped Beats:Present
   Axis:NormalRhythm:Mobitz I second-degree AVB
P:QRS ratio:6:5

This strip is classic for Wenckebach or Mobitz I second-degree AV block. We see a pause at the start and then a normal PR interval. The PR then begins to lengthen progressively throughout the rest of the group. Finally, the group terminates with a blocked P wave. The R-R interval shortens at the beginning of the group and then the shortening levels out, which is a bit atypical. The pause is less than the sum of two P-P intervals.

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