[Skip to Navigation]
Challenges in Clinical Electrocardiography
December 10, 2018

Bundle Branch Block Site in a Patient With a Right-Lying Heart and Wide QRS Complex

Author Affiliations
  • 1The Cardiovascular Institute of the First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning Province, China
  • 2Bridgeport Hospital, Yale New Haven Health System, Bridgeport, Connecticut
JAMA Intern Med. 2019;179(2):254-256. doi:10.1001/jamainternmed.2018.6709

A woman in her 30s was first noted to have the apex beat located on the right side of her chest at 2 years of age by her mother. She was referred for a cardiac evaluation after an electrocardiogram (ECG) performed on a routine health evaluation showed a wide QRS complex. The patient did not have chest wall deformity. The maximal cardiac impulse was noted to be in the right seventh interspace. A pathological diastolic murmur was detected at apex and the third and fourth intercostals at the right side of the sternum. Her initial ECG (Figure 1) showed that the P wave was positive in leads I and II, and negative in lead aVR (after limb lead misplacement was excluded). The PR interval was 140 milliseconds, and the QRS duration was prolonged (140 milliseconds) with slurred R waves in leads V1 through V6.

Add or change institution
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words