Finally. Picked Trifasicular Block for the first time, Alhamdulilaah ;) ❤️🩹
Positives here;
The combination of Left Axis Deviation (LAD), Right Bundle Branch Block (RBBB), and Mobitz Type II (most probably).
Btw
WHAT IS TRIFASICULAR BLOCK ON ECG?
**True Trifascicular Block**
True trifascicular block involves conduction delays in all three fascicles below the AV node (RBBB, LAFB, LPFB), leading to third-degree AV block with either RBBB + LAFB or RBBB + LPFB. Patients typically require a pacemaker due to the risk of complete heart block.
**Key Features:**
- 3rd degree AV block + RBBB + LAFB or LPFB
- Ventricular escape rhythm from left fascicles (showing as RBBB + LAFB/LPFB)
**Signs of Impending Block:**
- Alternating LBBB/RBBB or alternating fascicular blocks on a beat-to-beat basis may indicate imminent complete block and 3rd degree AV block.
**Misuse of the Term “Trifascicular Block”:**
- Clinically, “trifascicular block” is often used incorrectly to describe bifascicular block with 1st or 2nd degree AV block, but this doesn't increase the risk of complete block.
**Common Causes:**
- Ischemic heart disease, structural heart disease, aortic stenosis, anterior MI, Lenègre-Lev disease, hyperkalemia, digoxin toxicity.
**Management:**
- True trifascicular block requires pacemaker insertion.
- Bifascicular block with syncope/presyncope should be monitored closely, with potential pacing.
- Asymptomatic bifascicular block with 1st degree AV block typically doesn’t require pacing.
#Cardiology #HeartBlock #Pacemaker #ECG
Structural Heart Specialist
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