Careful analysis of ECGs is required to distinguish true alternating bundle branch block from baseline LBBB with RBBB escape complexes in high-grade AV block.
Demands meticulous ECG review to avoid mislabeling high-grade AV block as alternating BBB; leaves distinction hypothesis-generating pending larger series.
Alternating bundle branch block (ABBB) is a less commonly encountered phenomenon with the advent of re-perfusion therapy for acute myocardial infarction. ECGs simulating the appearance of an ABBB need to be carefully analysed. We present an ECG showing a baseline Left Bundle Branch Block(LBBB) progressing to a high grade AV block with escape complexes having a Right Bundle Branch Block (RBBB) morphology. Such an ECG can be mistaken for an ABBB if not analysed carefully.
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Bhimaraj et al. (2008) studied this question.
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