Prognosis of Trifascicular Block

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VOLUME 22, No. 2 SUMMER 1990 PROGNOSIS OF TRIFASCICULAR BLOCK Interesting Electrocardiogram PROGNOSIS OF TRIFASCICULAR BLOCK M. IREN~ FERRER, MD Consultant in Cardiology Metropolitan Life Insurance Company Professor Emeritus of Clinical Medicine, College of Physicians and Surgeons, Columbia University Consultant Electrocardiographer, Presbyterian Hospital, Columbia Presbyterian Medical Center, New York, NY This tracing was taken preoperatively on a 75-year-old female reports1~ have emphasized the difficulties of predicting out- with known heart disease who was taking digoxin, diuretics, come. In a group of 554 patientsI neither clinical, electrocar- nitroglycerine and theodur. It illustrates an IV conduction diographic or electrophysiologic studies alone or in defect that remains prognostically a problem. There is sinus combination provided means of identifying possible heart rhythm at 82/min. and a rare atrial premature contraction. block or sudden death. Myocardial failure, new infarcts, ar- There is a complete right bundle branch block and a marked rhythmias and the underlying heart disease accounted pri- ~) left axis deviation (-53 with a PR interval of 0.20-0.21 sec. -- marily for the deaths or development of complete block. slightly long. Thus the suspicion arises that there is trifascicular Prophylactic pacing has not reduced the incidence of sudden block present (RBBB, left anterior fasdcular block and decreased death in the group.2 or sluggish conduction through the left posterior fascicle). Thus it would appear that only careful follow-up, with the use There has been considerable concern in recent years as to the of Holter Monitor, exercise testing and electrophysiologic test- risk of sudden death, complete heart block or syncope in ing in symptomatic subjects, will resolve this difficult area in subjects with bifascicular and trifascicular block. Two recent cardiology. REFERENCES 1. Rahimtoola, S.H. and McNulty, J.H.: "High Risk" Bundle Branch Block. Hospital Practice 16: 73,1981. 2. Ezri, M., Lerman, B.B., Marchlinski, EE., Buxton, A.E., Josephson, M.E.: Electrophysiologic Evaluation of Syncope in Patients with Bifascicular Block, Am. Ht. J. 106: 693,1983. 152 JOURNAL OF INSURANCE MEDICINE VOLUME 22, No. 2 SUMMER 1990 I IIii 153.

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Definition of Terms Related to Cardiac Rhythm*
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