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.