Paroxysmal AV block (Ventricular standstill)

Paroxysmal AV block (Ventricular standstill)

-characterized by an abrupt and persistent AV block in the presence of otherwise normal AV conduction.

-may be initiated by:

conducted or blocked PAC or PVC

acceleration or slowing of sinus rhythm

**** in this case, we can see the slowing of the sinus rhythm.... went into 2:1 AVB then complete AVB with ventricular standstill.

-once the block is initiated, the block will persist until terminated by an escape, usually ventricular, with a predictable 

relationship of the escape to the following P wave

-most likely infra-His or subnodal and due to bilateral BBB (exact mechanism is unclear).

Reference: 

Fisch C and Knoebel SB. 2000. Electrocardiography of Clinical Arrhythmia. New York. Futura Publishing Co.

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