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Arrhythmia Recognition Webcast Series
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Practice ECG 28
This ECG is fairly benign at first glance. However, it is very deceptive. The interpretation process begins by noting an NSR with wide QRS complexes. The wide complexes match an RBBB pattern with slurred S waves in leads I and V6. Additionally, there are rabbit ears in V1. The axis is in the left quadrant and lead II is negative, so there is a left anterior hemiblock. This is, therefore, a bifascicular block with RBBB and LAH. The RBBB should immediately cause you to ask, "Is there concordance?" The answer is a resounding yes. There is concordance in II, III, aVF, and V3 to V6. This is an inferolateral pattern, and ischemia needs strong consideration in this patient.
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