PAT with Block: LBBB RSR' in V1
Report:
Atrial tachycardia 216/min with 2:1 block.
LBBB.
Comment:
The only indisputable part of the computer and the Cardiologist’s reports is tachycardia.
The tachycardia could not be sinus tachycardia even if there was a 1:1 conduction: the morphology of the atrial waves is retrograde, viz. negative in the inferior leads and upright in the three remaining standard leads, with a monophasic positive spike in V1.
In lead V1, the pattern is that of LBBB since the delay is in the left ventricular (i.e., negative) portion of the QRS. The unusual feature is the presence of a sharply demarcated secondary R wave. It becomes less so if one measures its relation to the atrial waves and finds it equidistant from the surrounding atrial deflections.
LAD is present in 50% of tracings with LBBB and appears to confer worse prognosis; this is the only reason to report it in the presence of LBBB. Some authorities believe that it represents additional pathology in the anterior superior fascicle of the left bundle branch and call it divisional LBBB36.
The sinus rhythm is shown below (Fig 60). Lead V1 has the expected rS morphology.
If you have any suggestions for or feedback on this report, please let us know.
Hi, can we chat about some terms and conditions?
The library and it's records are licensed under the Creative Commons Attribution 4.0 International license.
You are free to:
- Share — copy and redistribute the material in any medium or format for any purpose, even commercially.
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
- The licensor cannot revoke these freedoms as long as you follow the license terms.
Under the following terms:
- Attribution — You must give appropriate credit , provide a link to the license, and indicate if changes were made . You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
By clicking agree below, you are agreeing to adhere to CC BY 4.0.