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ECG REVIEW
ECG Reviews and Criteria
Le! Anterior Fascicular Block
(LAFB) ECG Review
A le! anterior fascicular block, also known as le!
anterior hemiblock, occurs when the anterior
fascicle of the le! bundle branch is no longer able
to conduct action potentials.

The criteria to diagnose a LAFB, or LAHB, on ECG

include the following:

1. Le! axis deviation of at least -45 degrees

2. The presence of a qR complex in lead I and a

rS complex in lead III

3. Usually a rS complex in lead II and III

(sometimes aVF as well)

A very quick way to diagnose a le! anterior

fascicular block on ECG is to first identify the le!
axis deviation; see image below. If the QRS complex
is up in lead I and down in lead aVF while also down
in lead II, then le! axis deviation is present. Then
look at lead III. If there is an rS complex, then you
have a LAFB on ECG. This method should take just a
few seconds.

Note: An old inferior wall myocardial infarction is

not able to be diagnosed in the setting of a le!
anterior fascicular block due to the inferior Q waves
present from the LAFB.

A le! anterior fascicular block can also occur in the

setting of a bifascicular or trifascicular block. Below
is a bifascicular block with a LAFB on ECG. Note
there is also a right bundle branch block.

ECG Examples:
Bifascicular Block - RBBB + LAFB ECG (Example
1)
Bifascicular Block - RBBB + LAFB ECG (Example
2)
Bifascicular Block - RBBB + LAFB ECG (Example
3)
Bifascicular Block - RBBB + LAFB ECG (Example
4)
Bifascicular Block - RBBB + LAFB ECG (Example
5)
Le! Anterior Fascicular Block (LAFB) ECG
(Example 1)
Le! Anterior Fascicular Block (LAFB) ECG
(Example 2)
Le! Anterior Fascicular Block (LAFB) ECG
(Example 3)
Trifascicular Block ECG (Example 1)
Trifascicular Block ECG (Example 2)
Trifascicular Block ECG (Example 3)

References:
1. Chou’s Electrocardiography in Clinical Practice:
Adult and Pediatric, 6e
2. Surawicz B, et al. AHA/ACCF/HRS
Recommendations for the Standardization and
Interpretation of the Electrocardiogram.
Circulation. 2009;
doi:10.1161/CIRCULATIONAHA.108.191095.

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