Fat Parents With Lean Children

Report:

Sinus rhythm

SVEBs

VEBs

Intraventricular conduction delay

Probable LBBB

QRS 0.14”

Ventricular fusion beats

Comment:

Rhythm strips are not the most reliable material for the diagnosis of a bundle branch block (or, for that matter, of anything else but the rhythm). Hence the report above states IVCD, probable LBBB.

The fusion beats in the top and middle strips are of normal duration. This is not surprising, looking at the ‘pure’ VEB in the bottom strip - it’s almost a mirror image of the supraventricular LBBB complexes. This is what Schamroth meant: two QRS abnormalities, combined, produce a normal QRS complex11. I call it lean children of fat parents.

The previous example, Case 7, had narrow fusion beats between RBBB and LBBB-like paced complexes.

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