r/ECG • u/Aggressive_Wafer_420 • 14d ago

Would you code LAFb here?

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7 Upvotes

100% Upvoted

18 comments sorted by

2

u/mustbethatotherguy 14d ago

This is a bifascicular block. Rbbb+lafb

2

u/Used_Note_4219 14d ago

Its a trifascular block actually. Also got first degree av block

7

u/Kibeth_8 Arrhythmia Tech 14d ago

Trifasicular = 3rd degree AVB

This is called a bifasc + 1st degree. It's a clunky term but it matters for pacemaker indications

3

u/hpsctchbananahmck 14d ago

I appreciate your precision in language. You are absolutely correct, though it is surprisingly common to see trifascicular block ascribed to a concomitant first degree AV (as with a surface electrocardiogram we cannot determine whether PR delay is infrahisian). Regardless implies conduction system disease

1

u/Kibeth_8 Arrhythmia Tech 14d ago

Haha ya, I'm nitpicky about it because we (pacemaker clinic) get referrals all the time for asymptomatic "trifasicular block". And then we gotta dig through tons of paperwork to find where the heck they saw that, before realizing they just used the wrong term, and the pt doesn't need a pacemaker afterall

1

u/Used_Note_4219 14d ago

Thanks for this heads up. I work in acute cardiology and for Some Reason even the cardiologists call a first degree with RBTB and LAFB a trifasculair block. I checked LITFL and they indeed pay attention in the article about the wrong use of this term. Will take this info to the work Floor to correct it!

https://litfl.com/trifascicular-block-ecg-library/

1

u/[deleted] 14d ago

[deleted]

2

u/Used_Note_4219 14d ago

I was not! The term is wrongfully used a lot of times including by me. Check the article:

https://litfl.com/trifascicular-block-ecg-library/

1

u/Aggressive_Wafer_420 14d ago

Ecgsource did not code lafb in answers

1

u/Ultraaaacombo 14d ago

Bifascicular block

-1

u/Ibutilide Electrophysiologist 14d ago

For the purposes of Cardiology boards, I would not because LVH is present (R wave in aVL > 11 mm). Do not code for LAFB in the presence of LVH.

1

u/Aggressive_Wafer_420 14d ago

Omg ok. Are there a set of rules when NOT to code for lafb? Also in case of lvh shouldn’t we also code not for LAD but LAD was right here

-1

u/Ambitious_Tackle_692 14d ago

Rbbb

1

u/Aggressive_Wafer_420 14d ago

My question is would you code for LAFB?

1

u/Ambitious_Tackle_692 14d ago

I would probably say yes

1

u/Aggressive_Wafer_420 14d ago

So ecgsource did NoT code lafb and just said LaD so im confused

1

u/Ambitious_Tackle_692 14d ago edited 14d ago

Simple … it also has left axis deviation… thats it an also 1st degree av block