This case demonstrates a rare ECG presentation of CRBBB with three different mean frontal plane QRS axes in a single tracing, reflecting complex conduction system disease that ultimately required permanent pacing.
Rare ECG pattern signals complex conduction disease in CRBBB warranting pacing consideration; leaves open prognostic value beyond this case.
A routine ECG of a seventy-year-old man, who had been followed for five years because of complete right bundle branch block (CRBBB) with first-degree atrioventricular (AV) block, showed CRBBB and three different mean frontal plane QRS axes suggesting normal conduction, bradycardia-dependent left anterior hemiblock, and tachycardia-dependent left posterior hemiblock--all within the same tracing. Holter recording demonstrated transient advanced AV block, and a permanent pacemaker was implanted.
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Nariaki Kanemoto (1988) studied this question.
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