A. Bifascicular heart block
Yes! The bifascicular block consist of right bundle branch block (RBBB) and left anterior hemiblock. The RBBB is seen as rSR’ (“M”) configuration of widened QRS complexes (more than 0.12 sec) in lead V1 and slurred wide S waves in lead V6. The left anterior hemiblock is seen as left axis deviation: the QRS complexes are mainly negative in lead III meaning that the electrical vector of the heart points the opposite direction from III. See more on bifascicular heart block in the library.
B. Right bundle branch block (RBBB)
Technically correct as the EKG shows rSR’ configuration of widened QRS complexes in V1 and slurred wide S waves in V6. However another abnormality is co-existent with RBBB in this EKG.
C. Left bundle branch block (LBBB)
No. There is no left bundle branch block configuration in lead V6. However the QRS complexes are widened (more than 0.12 sec) so a bundle branch block is not a bad suggestion.
D. Trifascicular block
No. Trifascicular heart block consists of right bundle branch block (RBBB), a hemiblock and first degree heart block. In this EKG both RBBB and left anterior hemiblock are present. However first degree heart block is not present (the PR interval is less than 0.22 sec.)
E. Second degree heart block
No. As all P waves are conducting there is no evidence of second degree heart block.
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{ 4 comments… read them below or add one }
I beg to differ. The PR interval shown is definitely indicative of a first-degree AVB.
RBBB + Left axis deviation ( Left anterior hemiblock) + 1st degree AV block = Trifasicular Block
It does look evident to previous comments..Looks like upon measurements, maybe borderline 1st degree AV/and for sure LAH/RBBB..tricky interpretation.. Thanks!!
Fellas, first of all the first degree av block is borderline at best. It might stretch past the .20 ms mark. However, even if it did in order to be included in a fascicular block it has to be in the right or left fascicule. An AV block occurs well prior to the fascicule.