January 9, 2016

Use all available leads in rhythm interpretation

Figure 1

A adult patient is admitted due to GI bleed.

What is the interpretation?

Figure 2

The rhythm is SR with long PR interval (first degree AV block), right bundle branch block (RBBB) and showing Wenckebach periodicity (aka Mobitz I) with 4:3 AV conduction.  If you rely only lead II, which is usually the monitoring lead. You will probably scratch your head. You have to utilize all available leads. Distinct P waves are marked with red arrow. The non-conducted beats are marked with black arrows.

The patient was asymptomatic and none was done for regarding the rhythm.



  1. LBBB + Tw inversion in V1-3 + epsilon waves in V4-5 => ARVD ?

  2. I think this is RBBB and the T wave inversions are part of the RBBB. Second, upsilon waves are seen in V1 are best seen in V1-V3.


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