How many BLOCKS can you see on this ECG.?


  20 years old male patient with episodes of dizziness.



In this patient with sinus rhythm, clearly there are some blocks on this ECG.

             1.       Right bundle branch block (RBBB), as was marked with red color.
                - QRS duration >120 ms
                - QRS with morphology rsR’ in lead V1 and slurred S wave in V6.
                 -Discordant T wave in V1.

       2.     Left anterior fascicular block (LAFB), as was marked with blue color.
                 - Left axis deviation, >-30
                 - qR in leads I and aVL and rS complexes in leads II and III
    
       3.    First-degree atrioventricular block, as was marked with red color.
                 - PR interval duration >200 ms.

The combination of RBBB, LAFB and First degree AVB is called Trifascicular block, which indicate presence of severe disease of heart electrical conduction system.

Besides trifascicular block, important finding is ventricular bigeminy.

Comments

  1. Krokus73March 20, 2018 at 7:02 AM

    The term "trifascicular block" for such situations is not currently used. The first degree block is not really a block, it only increases the conduction time between the atria and the chambers. The term "trifascicular block" is sometimes used in the case of the RBBB + LAH + the second degree AV block. I suggest the authors of the blog enrich their knowledge about current guidelines and principles, and not misleading readers.

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