Case B10. Complete Heart Block and Atrial Flutter. St Emlyn’s ECG Library.

Third degree block  stemlyns, ECG Library, #FOAMed, St. Emlyn’s ECG Library.

This EGG was recorded from a 69 year old woman with longstanding mitral regurgitation and renal impairment whodeveloped increasing exertional dyspnoea and orthopnoea. She had received treatment with digoxin and diuretics before admission to hospital. On the day of admission to hospital she had collapsed, loosing consciousness briefly and had become short of breath at rest.


Rhythm: There are regular P’ waves representing atrial depolarization present at a rate of approximately 220 per minute; an atrial tachycardia, most probably atrial flutter is present. The QRS complexes are also regular and occur at a rate of 40 per minute. The R – R intervals are constant but some contain five P’ waves while others contain sbc; in addition the P’R interval varies and it is therefore apparent that there is no relationship between the P’ waves and the QRS complexes: complete heart block is present. Morphology: The escape rhythm is broad complex (greater than .10 seconds) – the precise origin cannot be determined
from the surface ECG.


This patient was treated with a tempory pacemaker and the digoxin was withdrawn. She reverted to sinus rhythm with normal conduction.


Cite this article as: Simon Carley, "Case B10. Complete Heart Block and Atrial Flutter. St Emlyn’s ECG Library.," in St.Emlyn's, November 3, 2018,

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