Bilateral Bundle Branch Block (BBBB)
Report:
Sinus tachycardia 110/min
Left atrial abnormality (LAA)
Right axis deviation (RAD) +120o
Probable left posterior hemiblock
Right bundle branch block
ST/T changes consistent with infarction/ischaemia
Comment:
Three years previously, this patient had bradycardia 32/min secondary to a 2:1 AV block and LBBB (Fig 37a). The left bundle branch (or at least half of it) recovered sufficiently to transmit sinus tachycardia 110/min in the present trace. Thus, one can diagnose bilateral bundle branch block (BBBB) on the strength of both RBBB and LBBB in different ECGs.
Oddly enough, the LBBB shown below was divisional, with LAD. The half of the LBB that recovered was the one more severely damaged – or slower, anyway – three years previously.
By now, this patient had severe LV dysfunction and advanced (but graftable) triple vessel disease. He died two days after the RBBB trace was taken, awaiting transfer to Sydney for surgery.
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