McGill Case 217

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This case report is kindly provided by Michael Rosengarten from McGill and is part of the McGill Cases. These cases come from the McGill EKG World Encyclopedia.

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The rhythm is sinus with a first degree heart block (pr > 120ms), there is a wide QRS (>120ms.) with a RBBB morphology and a left axis deviation consistent with a left fasicular block. The combination has been called a "trifasicular block" suggesting that the prolonged pr interval is due to slowing in the left posterior fascicle, but in fact this can be due to slowed conduction in the A/V node.