title: Trifascicular block with intermittent complete atrioventricular block in a child.
abstract: Trifascicular block, which consists of impaired conduction in the three main fascicles of the ventricular conduction system, may progress to high-grade or complete atrioventricular block. It rarely occurs in children with a structurally normal heart. We report a case of trifascicular block in a previously healthy 9-year-old girl. The patient presented with repetitive seizures. The electrocardiogram showed a complete right bundle branch block, left axis deviation, PR interval prolongation, and intermittent high-degree and complete atrioventricular block. She was successfully treated with a temporary pacemaker and her electrocardiogram returned to a normal sinus rhythm in 3 days. She has remained well over a 4-year follow-up. Although her cardiac enzyme levels were normal, the clinical course and electrocardiography findings suggested myocarditis. We emphasize the diagnosis of trifascicular block using electrocardiography; clinical outcome is good, if the patient is managed properly.
authors.affiliation: Department of Pediatrics, National Cheng-Kung University Hospital, Tainan, Taiwan, ROC.
authors.forename: J M
authors.initials: JM
authors.lastname: Wu
authors.forename: J N
authors.initials: JN
authors.lastname: Wang
authors.forename: C S
authors.initials: CS
authors.lastname: Lin
authors.forename: W L
authors.initials: WL
authors.lastname: Lee
mesh_terms: D002648:Child; D004562:Electrocardiography; D005260:Female; D006327:Heart Block / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans