Rate dependent bundle branch block

We have previously discussed physiologic ventricular aberration with atrial ectopy or atrial fibrillation with a rapid ventricular response. There is another type of ventricular aberration, which is slower and represents abnormal bundle branch physiology. This is a rate dependent bundle branch block.

Complete heart block with no AV dissociation

AV with slow ventricular response. The rate is 40BPM. In the good old days this was digitalis toxicity until proven otherwise. The clue is Bifascicular block. Many cardiologists are reluctant to call this complete heart block as there is no AV dissociation.Don’t be scared to call this complete heart block because that is what it is!!

Wenckebach without a pause!

This week we had a Holter monitor recording reported as complete heart block. For obvious reasons this can be a serious diagnosis, but the reporting cardiologist felt it was Wenckebach sequences and requested a review.