ECG Findings
• QRS complex widening to 90 to 120 ms.
• Right axis deviation must be beyond 100 degrees and must have no other cause (such as lateral myocardial infarction).
• Small R wave and large S wave in the high lateral leads, I and aVL.
• Slurred S wave in V5 and V6.
• This example also contains unrelated ST changes.
Clinical Pearls
1. The signal exiting the AV node is carried rapidly to the upper aspect of the LV and all of the RV through the intact left anterior fascicle and right bundle, where depolarization is rapid. However, conduction to the inferior portion of the left ventricle is slower and must proceed cell-to-cell
due to the blocked left posterior fascicle. Therefore, the latter portion of the QRS depolarizes toward the inferior myocardium, manifesting as strong right axis deviation.
2. Left posterior fascicular block may be associated with acute inferior myocardial infarction as well as with multiple cardiomyopathic conditions.
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