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