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The ECG shows normal sinus P waves at a rate of 68 beats per minute (bpm). Every other P wave is conducted with a PR interval of 0.20 sec, resulting in a ventricular rate of 34 bpm. The QRS duration is 0.16 sec with right bundle branch configuration.
2:1 atrioventricular (AV) block is a form of second-degree AV nodal block. Below is an image from a different ECG demonstrating 2:1 AV nodal block.
2:1 AV block can occur as second-degree type I AV nodal block (Wenckebach) or second-degree type II AV nodal block. The distinction is clinically important; the former is usually benign while patients with Mobitz type II block should be managed with a permanent pacemaker. On this tracing, the evidence of diffuse conduction disease with prolonged AV conduction and right bundle branch block suggests this is type II block. Click the 2:1 AV Block ECG Review link below for more details on how to make this distinction.
Related Topic Reviews: 2:1 AV Block ECG Review, Right Bundle Branch Block