Recognition
- • RBBB (rsR' V1, wide QRS >120 ms)
- • PLUS left axis deviation (LAFB) OR right axis (LPFB)
Key findings
- • Trifascicular = bifascicular + 1° AV block on ECG
Clinical importance
- • Risk of progression to complete heart block, especially if symptomatic or in ACS
Management pearls
- • Ambulatory monitoring if syncope
- • Pacemaker if symptomatic bradycardia or alternating bundle branch block
