Right bundle branch block with changing axis at the end of atrial fibrillation

Abstract

Changing axis has been reported [1–8] also during atrial fibrillation [9–11] or atrial flutter [12,13]. Changing axis has been also reported during acute myocardial infarction [14–25] associated with atrial fibrillation too [26,27] or at the end of atrial fibrillation [28,29], also during acute myocardial infarction [30,31]. Dissimilar electrocardiographic patterns associated with right bundle branch block have been described [32]. Changing bundle branch block [14,33], new right bundle branchblock [34], rightbundle branchconductiondisturbances [35] and intermittent right bundle branch block [18] have also been reported in literature. We present a case of a right bundle branch block with changing axis at the end of atrial fibrillation in a 57-year-old Italian woman. A 57-year-old Italian woman was admitted to the Emergency Department with an atrial fibrillation. She reported the onset of palpitations approximately 2 h before. The ECG was performed and it showed a right bundle branch block with an atrial fibrillation (Fig. 1). The patientwas admitted to the Cardiology Unit. No pericardial effusion was observed at echocardiographic evaluation. After restoration of sinusal rhythm, the ECG showed right bundle branch block with changing axis and it was confirmed on ECG's surface performed on the following day (Fig. 2). Also this case focuses attention on changing axis.