A 73-year-old male presents with a history of hypertension and atrial fibrillation. Coronary artery bypass graft (CABG) was performed three years previously; recent coronary angiography showed all grafts to be patent. He is seen at this time due to an increased frequency of palpitations. An ECG is performed (Figure 1).
Figure 1
The correct answer is: D. All of the above.
The ECG shows sinus rhythm with a prolonged PR interval (230 milliseconds). The narrower beats (beats 2 and 5) occur after a longer cycle length and are approximately 115 milliseconds. The remainder of the beats demonstrate a QRS of approximately 122 milliseconds with left axis deviation. The ST/T changes noted in aVL are those typical for a left intra-ventricular conduction delay (LIVCD). This is a rate dependent LIVCD.
References
- Horwitz S, Lupi EH, Hayes, J, Frishman W, Cardenas M, Killi T. Electrocardiographic criteria for the diagnosis of left anterior fascicular block. Left axis deviation and delayed intraventricular
conduction. Chest 1975;68:317-20.
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