Key result
Proximal subocclusion of the LAD coronary artery caused transient left septal fascicular block with a giant slurring variant J-wave, indicating poor prognosis due to VT/VF risk.
Case Report (n=1)
Transient left septal fascicular block with a giant slurring variant J-wave in the setting of acute coronary syndrome is a critical ECG sign indicating high risk for ventricular arrhythmias and cardiac arrest.
May flag high-risk proximal LAD lesions in ACS; hypothesis-generating for LSFB with giant J-wave as prognostic marker.
We report a case of acute coronary syndrome with transient prominent anterior QRS forces (PAF) caused by proximal subocclusion of the left anterior descending (LAD) coronary artery before the first septal perforator branch. The ECG change indicates left septal fascicular block (LSFB) with associated slurring-type giant J-wave. Currently, this J-wave variant is considered as a lambda-like wave or QRS-ST-T "triangulation". Its presence is indicative of poor prognosis because of the risk for cardiac arrest as a consequence of ventricular tachycardia/ventricular fibrillation (VT/VF).
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Pérez‐Riera et al. (2018) conducted a case report in Acute coronary syndrome (n=1). Proximal subocclusion of the left anterior descending (LAD) coronary artery was evaluated. Proximal subocclusion of the LAD coronary artery caused transient left septal fascicular block with a giant slurring variant J-wave, indicating poor prognosis due to VT/VF risk.
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