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Fransen et al. [1] published a Heart Beat in this journal showing a case with rate-dependent left bundle branch block (LBBB) in a patient with serious hyperkalaemia. Critical appraisal of the ECGs, however, suggests that the hyperkalaemia by itself may be the explanatory mechanism of the LBBB rather than the increased heart rate. As shown in Fig. 1, the QRS complex immediately following a prolonged RR interval (10th QRS complex) is still widened, ruling out rate dependency as the underlying cause of left

Left bundle branch block in serious hyperkalaemia: rate-dependency?