Talk:Puzzle 2008 04 014 Answer: Difference between revisions

With interest I read the comment of the ecgpedia visitor on our previously published rhythm puzzle. First, it is important to state that in our answer to the puzzle, we say that figure 1B shows a combined right bundle branch and left anterior fascicular block ''configuration''. This statement does not include an explanation for this configuration. Furthermore, the ECG as depicted in figure 1B shows a regular rhythm of nearly 100 bpm, which makes a junctional escape rhythm, as stated by the visitor, unlikely.  

An accelerated idioventricular rhythm (AIVR) is frequently observed in the setting of acute myocardial infarction. It is usually a broad complex rhythm at a frequency of 60-120 bpm originating from the ventricular myocardium. If AIVR originates nearby the left posterior fascicle of the left bundle, this will result in ventricular conduction and activation with a likely ''configuration'' as shown in figure 1B.

Hi, thanks for your quick response.