EMS 12-Lead: The 12 Rhythms of Christmas – Paroxysmal AV-Block

This article is the ninth in our latest series, The 12 Rhythms of Christmas, where we examine a different rhythm disorder with each new post. It’s a continuation of the theme behind last year’s 12 Leads of Christmas. And, just like last year’s series, I’m rather late getting the final articles out, but the end is in sight.

Hope you had a good Valentine’s Day—let’s talk about some heart stuff. Today I want to discuss a form of AV-block that many providers don’t even realize is its own unique entity: paroxysmal AV-block.

What differentiates this arrhythmia from the other AV-blocks is that it occurs in discrete, self-limited episodes—or “paroxysms.” You patient will be hanging out, minding their own business, when out of nowhere they suddenly drop two or three or forty QRS complexes in a row until the AV-node just as suddenly recovers. It tends to give you a pretty good wake-up.

Paroxysmal AV-block. Click to enlarge

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