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Patient
78-year-old man with no known history, hospitalized for traumatic syncope;
Trace
Complete right bundle branch block pattern (QRS duration > 120 ms, rR' or RsR' pattern in V1-V2, delayed intrinsicoid deflection in V1, wide S wave in V5-V6, repolarization disorders in V1-V3) associated with a left posterior fascicular block (marked right axis, rS pattern in lead I and qR pattern in leads II, III);
Exergue
A major right axis deviation in a patient with a right bundle branch block may reflect the presence of right ventricular hypertrophy or associated left posterior fascicular block. The presence of a qR pattern in leads II, III is rather in favor of an associated left posterior fascicular block.
This patient presents a bifascicular block with association between complete right bundle branch block and left posterior fascicular block. This form is much less common than the right bundle branch block + left anterior fascicular block association and certainly much more worrisome.