Sudden unexpected improvement in the atrioventricular conduction. What is the mechanism?

Abstract

The 12-lead electrocardiogram (ECG) of a 79-year-old male patient with recurrent pre-syncope showed irregular sinus rhythm with constant PR interval and left bundle branch block (LBBB) with intermittently blocked P waves. The beat following the blocked P wave had a narrower QRS with a shorter PR interval. The phenomenon of bilateral bundle branch block explains the sudden improvement in the atrioventricular conduction.

Keywords

• LBBB
• Bilateral bundle branch block
• Ladder diagram
• Electrocardiogram