Electrocardiogram of an 83 year-old man with hypertension, hyperlipidemia, type 2 DM, quaiescent coronary artery disease and recurrent syncope.

Rate 67/min
PR 0.29 sec
QRS 0.18 sec
QT 0.46 sec
QTc 0.48 sec
QRS axis -75º

Interpretation: Abnormal. First degree A-V block. Left axis deviation, left anterior fascicular block. Right bundle branch block with secondary repolarization changes.

Prolonged PR interval may be due to delayed conduction in the remaining division of the left bundle branch (trifascicular block) or may reflect conduction delay in the AV node. An H-V interval over 100 msec identifies patients with high degree A-V block who require permanent pacing.

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