Figure 200i
Reversed splitting of S2 with paradoxical
movement in a patient with
complete LBBB. A2 is confirmed by the simultaneous indirect carotid
pulse and with inspiration there is slight narrowing of the splitting
interval. At cardiac catheterization, a marked increase in the Q to
left ventricular rise interval of 80ms was documented and was primarily
responsible for the delayed A2. A slight increase in the isovolumic
contraction time was also present.