Incomplete LBBB
Report:
Sinus rhythm 94/min
Incomplete LBBB
Comment:
The QRS is just over 0.10â long and, despite large voltages, there are no âseptalâ q waves in 1, aVL and V6. The last of these also shows delayed intrinsicoid deflection, but nobody looks at that any more.
The anteroseptal QS complexes may be due to infarction (usually with smaller voltages), LVH (present in 90% patients with incomplete LBBB) or LBBB (complete or incomplete). The LVH criterion of RV6 > RV5 has not been validated for LBBB and is certainly invalid with anteroseptal infarcts.
Below is the admission ECG, taken before she was cooled to 34oC. The QT interval is obviously (over 50% or R-R interval) prolonged, but this was most likely due to hypoxic brain injury and amiodarone given for the original VF and subsequent runs of VT.
The patient was eventually found to have LV non-compaction as the cause of her cardiomyopathy. She received an ICD after elective Cæsarian section and was discharged home after 4 months in hospital, most of it in ICU and CCU.
Fig 30a. Admission ECG.
Fig 31. 66 year old man with carcinomatosis, admitted with chest pains to CCU
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