Below are my thoughts on this rhythm:

Underlying Sinus rhythm with 2nd degree AV block Mobitz I (Wenckebach) and junctional escape beats.

To help with my explanation, please see the annotated pictures below

It's a shame that I can't seem to remember everything all the time. In an effort to keep this fact in mind, here's a short educational thread on RR-intervalls in Type I 2nd degree AV-Block (in Germany we like to call it Wenckebach). 1/

Normally, with cycles of Wenckebach, we see each cycle begin with the same PR - however, this is not the case in this example. Its a little tricky to explain, but I believe this is due to a shorter preceding RR interval, compared to PR 1.

This rhythm may seem a little atypical at first, because the second cycle of Wenckebach conduction starts with a different PR interval to the first cycle (PR 1 is different from PR 2 - see picture below)

Black arrows = Sinus P waves
Purple arrows = Junctional escape beats triggered by the pauses from non-conducted sinus beats
Blue arcs = PR prolongation
Red cross = P waves failing to conduct due to Wenckebach AV block

#EPeeps Same patient that previously had 6:2 flutter, now having “variable conduction” which is upper level 2:1 and lower level Wenckebach!

Andreas Roeschl, MD How do you know it’s mobitz 2 versus Wenckebach when 2:1?

Dr.Fujisawa@ECGマイスター 循内以外の症状なしの初回Wenckebach Ⅱ°AVBはうちの検査室でも報告するか意見が割れます。
覚醒時に記録した際にWenckebach Ⅱ°AVB を認めた際には一度ホルターで就寝時にCAVBとかに移行してないか確認した方がいいのでは？と思うので私は報告をと考えるのですが、報告不要派の人もいまして…。

Dr Joshua Walinjom Inferior MI because of the ST elevations leads II and III.
Wenckebach phenomenon in v1-6?
Right coronary artery
Treatment: MONA

I hate ECGs 😅😅

Dodz Wenckebach is correct.

Nice you saw that .

PR 2 has a longer PR than PR 1 because the AV-His bundle has only just depolarised, i.e. the junctional escape beat before PR 2 has slowed conduction through the AV node for the next beat (due to AV-his disease), similar to the second beat in the first Wenckebach cycle.

心電図道場 Wenckebach Ⅱ°AVB

John Shields, MD, FAAOS Many medications increase the QT interval with an incremental dose-dependent non-linear hike in the probability of arrhythmia such as Wenckebach 😉.

#dgimkongress 2024 in Wiesbaden

Vielen Dank für die Möglichkeit die
„Karel Wenckebach Lecture“
zu halten!

Eine echte Ehre 🙏

DGIM
Daniel Steven Kevin Vernooy

Answer :

1. Inferior myocardial infarction, with second degree A-V block, Wenckebach type.

2. Right coronary artery

3.
-Monitor/defibrillator with Pads on
- Aspirine 250mg Iv
- Ticagrelor 180 mg
- Heparine 5000IU
-Morphine 3-5mg iv
-0xygen if desaturating

- immidiate

Rhythmusdiagnostik zu jedem Zeitpunkt? Perfekte ‚Karel Wenckebach Keynote lecture‘ von Dominik Linz beim #DGIM : Viele Antworten bei verbleibenden Fragen zur OAK. EP_Bot Philipp Sommer Arian Sultan AGEP

心電図道場 2:1 房室ブロック

※3:2伝導以上の箇所が見られないため、WenckebachかMobitzⅡ型かの鑑別は出来ない。

You wink at me😉, I Wenckebach💓

心電図道場 Wenckebach型Ⅱ度AVB