Santiago Obregón-Rosas M.D. , Jessica Michelle Flores-Guerra M.D. , Ángel Antonio Montañez-Aguirre M.D. , Pedro Iturralde-Torres M.D. , Karina del Valle Zamora M.D.
{"title":"First electrocardiographic documentation of alternating bilateral block in pulmonary embolism","authors":"Santiago Obregón-Rosas M.D. , Jessica Michelle Flores-Guerra M.D. , Ángel Antonio Montañez-Aguirre M.D. , Pedro Iturralde-Torres M.D. , Karina del Valle Zamora M.D.","doi":"10.1016/j.jelectrocard.2025.154057","DOIUrl":null,"url":null,"abstract":"<div><div>Massive pulmonary embolism (PE) classically produces sinus tachycardia or right bundle-branch block (RBBB). We report a 46-year-old woman whose initial electrocardiogram showed simultaneous left and right anterior fascicular block—the first description of bilateral anterior fascicular block. Days later the tracing converted to complete RBBB with left posterior fascicular block (LPFB), a recognised bilateral pattern, documenting the first alternation from bilateral anterior fascicular block to the RBBB + LPFB combination. This sequence suggests diffuse, pressure-induced His–Purkinje injury and may herald haemodynamic collapse; the patient died intra-operatively. Alternating bilateral fascicular patterns could serve as early electrocardiographic warnings in massive PE.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"92 ","pages":"Article 154057"},"PeriodicalIF":1.3000,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of electrocardiology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0022073625001852","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Massive pulmonary embolism (PE) classically produces sinus tachycardia or right bundle-branch block (RBBB). We report a 46-year-old woman whose initial electrocardiogram showed simultaneous left and right anterior fascicular block—the first description of bilateral anterior fascicular block. Days later the tracing converted to complete RBBB with left posterior fascicular block (LPFB), a recognised bilateral pattern, documenting the first alternation from bilateral anterior fascicular block to the RBBB + LPFB combination. This sequence suggests diffuse, pressure-induced His–Purkinje injury and may herald haemodynamic collapse; the patient died intra-operatively. Alternating bilateral fascicular patterns could serve as early electrocardiographic warnings in massive PE.
期刊介绍:
The Journal of Electrocardiology is devoted exclusively to clinical and experimental studies of the electrical activities of the heart. It seeks to contribute significantly to the accuracy of diagnosis and prognosis and the effective treatment, prevention, or delay of heart disease. Editorial contents include electrocardiography, vectorcardiography, arrhythmias, membrane action potential, cardiac pacing, monitoring defibrillation, instrumentation, drug effects, and computer applications.