• Conduction blocks in all 3 fascicles
– Can be permanent or transient
– 1) RBB and LASF w/1st degree AV block
– 2) RBB and LPIF w/1st degree AV block
– 3) LBB w/1st degree AV block or
– 4) Alternating RBBB and LBBB
• Trifascicular, along w/bifascicular, blocks
indicate advanced heart dz
• BUT long-term follow-up studies of
ambulatory patients indicate that risk of
sudden progression to complete heart
block and sudden death d/t ventricular
asystole is not great
Bolton Edmund, "Chapter 28. Disturbances of Cardiac Rhythm and Conduction" (Chapter). Tintinalli
JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM: Tintinalli's Emergency Medicine: A
Comprehensive Study Guide, 6e: http://www.accessmedicine.com/content.aspx?aID=587596.
Assessment and Plan
• Dr. Quesada’s Assessment and Plan: These
findings suggest a trifascicular block.
Progression of chronic bifasicular or trifascicular
block to complete heart block is infrequent. This
pt is asx and was very active prior to
• Per guidelines, the pt has intermediate to high
clinical predictors (DM asx trifascicular block)
and is scheduled for a low risk surgical
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