Bundle Branch Blocks

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    84 year old female with heart palpitations.

    78 year old female with heart palpitations.

    Questions

    Question 1: Why is the PVC (complex 11) more narrow than the conducted beats?

    Key Findings

    - Atrial fibrillation with rapid ventricular response

    - Left bundle branch block

    - Premature ventricular beats

    Coding for the Boards

    - Atrial fibrillation

    - Left bundle branch block

    - Premature ventricular complex

    Answers

    Question 1: The PVC likely originates within or near the His-Purkinje system below the level of block responsible for the LBBB.