EKG of the Week 2018 9-9

This EKG comes courtesy of Dr. Yousseff.

A 25 year old male presented to participate in an elective research study. He had no complaints. A screening EKG was performed.

Vital Signs: Pulse – 50, R -16, BP 120.70.

His EKG is below.

2018 9-9.jpg

1.       What is the rhythm?

2.       How would you manage this patient?


The rhythm is 3rd degree AV block. In this patient it turned out to be congenital.

This patient is asymptomatic. In asymptomatic congenital complete AV block, no specific treatment is needed.


The EKG demonstrates a bradycardia with dropped P waves, regular R-R intervals and irregular P-R intervals. This is consistent with 3rd degree AV block.

In congenital 3rd degree AV block, treatment depends on whether or not the patient has structural cardiac abnormalities. If the echocardiogram demonstrates structural abnormalities of the heart, treatment includes placement of a permanent pacemaker. If there are no structural abnormalities and the patient is asymptomatic, pacemaker placement can be delayed.

In this patient, he remembered being told as a child that he had “some kind of block in his heart”. He in fact had congenital 3rd degree AV block. His echo was normal. So, placement of a pacemaker was delayed. Ultimately most of these patients become symptomatic at some point in their life and they then require pacemaker placement.

The algorithm below is helpful for diagnosing bradyarrhythmias.

Bradycardia algorithm.jpg