Atypical LBBB
Report:
Sinus rhythm 70/min
Borderline left atrial abnormality
Left bundle branch block
Comment:
The S wave downstroke is slurred, while the upstroke is brisk, like in VEBs. This is unusual, most likely due to an old infarction. In every other respect, however, this is a LBBB, shown here as an exception to the rule.
Slow S descent in V1 is one of the most useful criteria for diagnosing ventricular ectopic origin of broad complexes. Luckily this trace is in sinus rhythm; an SVT or flutter could easily be thought to be VT.
Fig 74. 81 year old lady with history of remote MI and recent exacerbation of cardiac failure.
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