Transient left septal fascicular block in the setting of acute coronary syndrome associated with giant slurring variant J-wave

Ann Noninvasive Electrocardiol. 2018 Nov;23(6):e12536. doi: 10.1111/anec.12536. Epub 2018 Feb 24.

Abstract

We report a case of acute coronary syndrome with transient prominent anterior QRS forces (PAF) caused by proximal subocclusion of the left anterior descending (LAD) coronary artery before the first septal perforator branch. The ECG change indicates left septal fascicular block (LSFB) with associated slurring-type giant J-wave. Currently, this J-wave variant is considered as a lambda-like wave or QRS-ST-T "triangulation". Its presence is indicative of poor prognosis because of the risk for cardiac arrest as a consequence of ventricular tachycardia/ventricular fibrillation (VT/VF).

Keywords: acute coronary syndrome; giant slurring variant J-wave; prominent QRS anterior forces; transient left anterior fascicular block.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Acute Coronary Syndrome / diagnosis*
  • Acute Coronary Syndrome / etiology
  • Acute Coronary Syndrome / therapy*
  • Aged
  • Angioplasty, Balloon, Coronary / instrumentation*
  • Angioplasty, Balloon, Coronary / methods
  • Bundle-Branch Block / complications
  • Bundle-Branch Block / diagnosis*
  • Chest Pain / diagnosis
  • Chest Pain / etiology
  • Coronary Stenosis / complications
  • Coronary Stenosis / diagnosis
  • Coronary Stenosis / therapy*
  • Electrocardiography / methods*
  • Humans
  • Male
  • Prognosis
  • Severity of Illness Index
  • Stents
  • Treatment Outcome