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(Circulation. 1971;44:1111.)
© 1971 American Heart Association, Inc.

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Mobitz Type II Block without Bundle-Branch Block

KENNETH M. ROSEN M.D.¹; HENRY S. LOEB M.D.¹; ROLF M. GUNNAR M.S., M.D.¹; SHAHBUDIN H. RAHIMTOOLA M.B., M.R.C.P.E.¹

¹ From the Department of Adult Cardiology of the Hektoen Institute for Medical Research and Cook County Hospital and the Department of Medicine of the Abraham Lincoln School of Medicine, University of Illinois College of Medicine, Chicago, Illinois.

His bundle (H) electrograms were recorded in three patients with Mobitz type II block and narrow QRS. Block was secondary to digitalis intoxication in one patient. In the second patient, who had first-degree A-V block, type II block occurred with atrial pacing at a slightly increased heart rate. In the third patient, who had corrected transposition of the great vessels, type II block occurred spontaneously. In two additional patients, block simulating type II block was noted. In one, block of single P waves occurred with carotid massage. In the other, Wenckebach periods with small increments in P-R (and P-H) intervals resembled episodes of type II block. In all five patients, block was proximal to H, suggesting the A-V node as the site of block. The conduction defects in these patients were not progressive; none of the patients needed a pacemaker.

Although these mechanisms were identified in patients with narrow QRS complexes, they could occur with bundle-branch block suggesting an erroneous diagnosis of bilateral bundle-branch disease. It is concluded that His bundle recording is helpful in delineating these benign forms of block. The site of block may be a more important determinant of prognosis than the type of block.

Key Words: Wenckebach block • His-Purkinje system • Digitalis intoxication • Bilateral bundle-branch block • A-V conduction

Submitted on March 18, 1971
Accepted on August 13, 1971

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