70 year old male presents post collapse

A 70 yo male presents to the emergency department following a collapse at home. There is no prodrome and he does not remember the incident.
​His ECG is shown below. What is the diagnosis?

There is also a prolonged QTc of about 500. 
There is also a:

• First degree block
• RBBB
• LAFB

I would call this a Trifascicular Block.
​Cardiology argued that it was not. Read on to see why they were wrong.

What are the 3 Fascicles?

As the HIS Purkinje system enters the ventricular part of the heart it is composed of the:

1. Right Bundle: which forms one fascicle
2. Left Bundle, which is split into:
   1. Anterior and 
   2. Posterior fascicles

...Thus 3 fascicles.

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Author

Dr Peter Kas
MBBS MArch BArch FACEM