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Differentiating the five main causes of Mobitz type 1 AV block depends on the degree and the time of onset of the block. Ischemic heart disease is not generally considered an initiating factor for AV conduction abnormalities. However, hypokalemia causes the sinus node to slow down, and when the sinus node rate slows down in hypokalemia, it usually causes the Wenckebach phenomenon. Third-degree AV block is seen when the atria are exposed to a high degree of vagal stimulation from a central nervous system disorder such as herpes encephalitis, trauma, meningitis, brain tumors, and epilepsy.

Third degree (incomplete). Third-degree AV block is a pattern of AV block (Mobitz type III) in which the PR interval is greater than 500 milliseconds in duration (Figure 8.1). In Mobitz type III AV block, the P waves are buried in the preceding T wave, and frequently it is useful to check the P wave shape. The P waves are frequently inverted in this type of block, and atrial fibrillation can occur.

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