Relation of QRS Vector and Transverse Ring in Left Bundle
Branch Block: Case Report
Volume 6 - Issue 2
Hassa Iftikhar1*, Ya Li2 and Akanganyira Kasenene3
- 1Department of Cardiology, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology (HUST). Wuhan,
Hubei, PR China
- 2Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, Hubei, PR China
- 3Department of Imaging and Nuclear Medicine, Zhejiang University, Hangzhou, PR China
Received: May 5, 2021 Published: May 20, 2021
Corresponding author: Hassa Iftikhar, Department of Cardiology, Tongji Hospital, Tongji Medical College of Huazhong University of
Science and Technology (HUST). Wuhan, Hubei, PR China
DOI: 10.32474/RRHOAJ.2021.06.000237
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Background: Electrophysiological studies always remained essential to differentiate the type of pre-excitation syndrome in
arrhythmia. We explore mahaim fibers’ role instead of a bundle of his in the accessory pathway to diagnose left bundle branch block.
Case presentation: A asymptomatic 51-year-old man was present in the outpatient department with a history of myocardial
infarction over several years. The classical pre-excitation syndrome remains classical without delta waves. Trans-esophageal atrial
pacing was induced using electrocardiogram and intracardiac electrogram (IEGM) to study further morphological changes of QRS
in all directions.
Diagnosis: The evaluated accessory pathway before and after ablation at anterolateral bypass potentially synchronous the
transitional R wave at the electrical axis, recording the positive and negative sign readings. The morphology pattern closer to the
left bypass’s origin at the frontalis concludes the left bundle branch block, which was misdiagnosed earlier with the right bundle
branch block.
Conclusion: This is the first case report which elaborated the importance of retrograde study in uni-directional stimulus that
significantly identified the maximum QRS terminal vector changes in rhythm disorder.
KeywordsPre-Excitation; QRS Terminal Vector; Mahaim Fiber; Left Bundle Branch Block; Ablation.
Abbreviations:ECG: Electrocardiogram; SVT: Supraventricular tachycardia; AP: Accessory pathway; PS2 : Phase segment;
AH interval: Atrial his interval; AV node: Atrioventricular node; NV node: Nodo-ventricular node; STEMI: ST-elevation myocardial
infarction; NSTEMI: Non-ST elevation myocardial infarction; RBBB: Right bundle branch block; LBBB: Left bundle branch block
Abstract|
Introduction|
Case Presentations|
Discussion|
Limitation of Study|
>Conclusion|
Patient Perspectivet|
Reference|