What would you make of a patient who previously demonstrated left anterior fascicular block on an ecg, and on a later ecg presented with fractured qrs, right axis deviation, delta waves and j point? ecgs were recorded properly/no technician error?

A delta wave is something seen in WPW syndrome which is very basically an electrical pathway in the conduction system of the heart that can cause an abnormally fast hear rate. There is no emergency but have the ECG evaluated by a cardiologist.

No clinical details which makes interpretation difficult. Assuming that the rhythm is sinus and not idioventricular, one would suspect progression of conduction abnormality due possibly to cardiac damage. I suggest that the ECG And the PATIENT be evaluated by a cardiologist. It is foolish to speculate further.