ECG of the Week - 10th October 2016 - Interpretation

The following ECG is from a 83 yr old female who presented to her GP with a 1 week history of exertional dysponea. She is normal fit and well and takes no regular medication. 
The ECG machine interpretation reads 'sinus bradycardia, 1st degree AV block, right bundle branch block'.  What do you think ?

Click to enlarge

Rate:

• 42 bpm Ventricular rate
• 102 bpm Atrial rate

Rhythm:

• Regular atrial & ventricular rhythms
• AV dissociation

Axis:

• Normal

Intervals:

• QRS - Prolonged

Additional:

• Typical RBBB morphology

Interpretation:

• Complete heart block

What happened ?

The patient was admitted under cardiology for pacemaker insertion and made an uneventful recovery following.

References / Further Reading

Life in the Fast Lane

• Complete heart block 

Textbook

• Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.