Right bundle branch block with left anterior hemiblock

Right bundle branch block with left anterior hemiblock

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Bifascicular block manifested as right bundle branch block with left anterior hemiblock. Slurred S waves in lateral leads and slurredR waves in V1 are suggestive of right bundle branch block (RBBB). The initial r wave is missing in V1 and V2, possibly due to an old anterior wall myocardial infarction. Left axis deviation with rS pattern in inferior leads and qR pattern in aVl suggests associated left anterior hemi block. The QRS width is increased, as part of the complete right bundle branch block pattern. T wave inversion in V1 to V3 could be due to right bundle branch block or previous anterior wall myocardial infarction.