What is the defining feature of 2nd degree block / Wenckebach?

The defining feature of a second-degree heart block, specifically type I (Wenckebach), is the progressive prolongation of the PR interval (PRI) with each successive beat until a QRS complex is dropped. This pattern results from a gradual lengthening of the time it takes for the electrical signal to travel from the atria to the ventricles through the AV node.

It is important to note that in this type of block, the P waves occur regularly with a predictable rhythm, but as the PR interval lengthens, it ultimately leads to the failure of some impulses to propagate to the ventricles, resulting in the dropping of a QRS complex.

Understanding this pattern is crucial for practitioners, as it differentiates Wenckebach from other types of heart blocks. In contrast, other types of blocks might show immediate conduction of every P wave, a consistent PRI, or mechanisms such as rapid declines in electrical impulses, which do not apply in this scenario.