Rate-Dependent LBBB

Report:

Sinus rhythm 90/min

SVEBs, blocked, in bigeminy

Left bundle branch block, rate-dependent

Comment:

The blocked atrial extrasystoles are discretely etched on the onset of the T wave. In the upper strip, the last LBBB complex has a distinctive nipple on its ST/T wave. The blocked P’ waves are more difficult to see but remain still discernible in the same position of normal complexes’ ST/T waves. The last normal complex and its LBBB successors have no wrinkles in the ST/T region, and normal sinus rhythm persists. A sustained run of blocked bigeminal SVEBs could be mistaken for sinus bradycardia 50/min.

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