Right bundle branch block

1. RIGHT BUNDLE BRANCH RIGHT BUNDLE BRANCH
BLOCKBLOCK
Different Different
presentations of presentations of
RBBB in ECG RBBB in ECG
illustrationsillustrations

DR. SHAZIADR. SHAZIA

2. Normal Ventricular ConductionNormal Ventricular Conduction

Normal ConductionNormal Conduction

fibers of LBB begin conductionfibers of LBB begin conduction

impulse travels across impulse travels across
interventricular septum from left to interventricular septum from left to
rightright

towards + electrode creates small r towards + electrode creates small r
wavewave

travels across ventricles causing travels across ventricles causing
depolarization of both depolarization of both
simultaneouslysimultaneously

LV contributes most to complexLV contributes most to complex

impulse travels away from + impulse travels away from +
electrode creates primarily electrode creates primarily
negative complexnegative complex

3. RBBBRBBB

RBBB in V1RBBB in V1

no change in initial impulse no change in initial impulse
traveltravel

small r wavesmall r wave

impulse depolarizes LV by impulse depolarizes LV by
itself since RBBBitself since RBBB

RV depolarized by impulse RV depolarized by impulse
thru musclethru muscle

it now contributes to it now contributes to
complex complex

travels toward + electrode travels toward + electrode
creating positive deflectioncreating positive deflection

5. Right Bundle Branch BlockRight Bundle Branch Block
CriteriaCriteria

QRS duration QRS duration ≥≥ 110ms 110ms
rSR’ pattern or notched R wave in VrSR’ pattern or notched R wave in V
11
Wide and slurred S wave in I and VWide and slurred S wave in I and V
66

6. R-R Pattern in RBBB and LBBBR-R Pattern in RBBB and LBBB

7. DIFFERENCE BETWEEN RBBB AND DIFFERENCE BETWEEN RBBB AND
LBBBLBBB

8. BBB RecognitionBBB Recognition

Use V1Use V1

Find Terminal forceFind Terminal force

Identify direction of terminal forceIdentify direction of terminal force

Downward Downward  LBBB LBBB

Upward Upward  RBBB RBBB

Picture a Steering WheelPicture a Steering Wheel

Right turn Right turn  turn signal goes up turn signal goes up

Left turn Left turn  turn signal goes down turn signal goes down

9. BBB RecognitionBBB Recognition

Terminal Force in V1Terminal Force in V1

direction of deflection prior to J pointdirection of deflection prior to J point
J point

10. ECG ILLUSTERATIONSECG ILLUSTERATIONS
COMPLETE RBBBCOMPLETE RBBB

11. INCOMPLETE RBBB; rSR pattern with normal INCOMPLETE RBBB; rSR pattern with normal
QRS durationQRS duration

12. INTERMITTANT RBBB WITH SINUS INTERMITTANT RBBB WITH SINUS
RHYTHMRHYTHM

13. RBBB and LAFBRBBB and LAFB

14. IDENTIFY QUESTIONSIDENTIFY QUESTIONS
ANS:COMPLETE RBBBANS:COMPLETE RBBB

15. ANS: RBBB with left anterior fascicular blockANS: RBBB with left anterior fascicular block

16. ANS. INCOMPLETE RBBBANS. INCOMPLETE RBBB

17. ANS: INTERMITTENT RBBBANS: INTERMITTENT RBBB