This cardiogram show the characteristics of "trifasicular block". The QRS duration of139 ms indicates a conduction disturbance, the tall R wave and S wave in V1 and V6 support the diagnosis of right bundle branch block, the deep S wave in lead II with the QRS axis of -78 degrees supports the diagnosis of lef anterior fasicular block. Finally the prolonged PR interval suggest conduction slowing in the remaining fasicle, although this delay could also be in the A/V node.

In this case the tracing is probably a true trifasicular block, given the history of this patient being implanted for symptomatic complete heart block (rate 25/min) one week earlier.