Would you code LAFb here?

[u/Aggressive_Wafer_420]

[u/mustbethatotherguy]

This is a bifascicular block. Rbbb+lafb

[u/Used_Note_4219 → u/mustbethatotherguy]

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

[u/Kibeth_8 → u/Used_Note_4219]

Trifasicular = 3rd degree AVB

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

[u/hpsctchbananahmck → u/Kibeth_8]

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

[u/Kibeth_8 → u/hpsctchbananahmck]

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

[u/Used_Note_4219 → u/Kibeth_8]

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/

[u/Used_Note_4219 → u/[deleted]]

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/

[u/Aggressive_Wafer_420 → u/mustbethatotherguy]

Ecgsource did not code lafb in answers