Q. Do I need pacemaker based on my EKG reports?

Answered by
Dr. Lohit Chauhan
and medically reviewed by Dr. Divya Banu M
Published on Mar 14, 2019

Hi doctor,

I am a 37-year-old female, 140 lbs 5’5". I saw a new cardiologist yesterday and my EKG results. Results said left axis deviation, LAPB, RBBB. I asked her if I have a bundle branch block and she said no because only the two heartbeats show it and the rest of the EKG was normal. I am worried whether I need a pacemaker if I have blocks now. What is she trying to say?

Dr. Lohit Chauhan

General Medicine Internal Medicine


Welcome to icliniq.com.

I guess you mean LAFB and not LAPB. According to you, you already have RBBB and this time the EKG strip read LAFB. Many times the EKG strips read the EKG strip wrongly. You should believe in your cardiologist as humans are needed to interpret the EKG with some specific criteria, to fit the EKG as normal or some pathology.

While LAFB stands for left anterior fascicular block, there is no term such as LAPB in my knowledge. The other term is LPFB, which stands for the left posterior fascicular block. The LPFB is extremely rare and usually occurs in isolation. It would be nice if you could post the picture of your EKG so that I could give a second opinion. Also when RBBB is present in combination with the other two (either LAFB or LPFB) is called bifascicular block. If the bifascicular block is present chronically in a patient it has a relatively low risk of progression to a high degree block.

Thank you doctor,

It also said left axis deviation on my EKG. What does that mean?

Dr. Lohit Chauhan

General Medicine Internal Medicine


Welcome back to icliniq.com.

Axis in an EKG is determined by a variable on the strip which is known as QRS complex. Normally the QRS axis falls in between -30° to +90°, anything beyond -30° is called as left axis deviation. The most common cause of LAD is a hemiblock (left anterior fascicular block). It can be present in some individuals normally also. If you had hypertension in the past, it could be due to left ventricular hypertrophy (which is a complication of long term hypertension).

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