Right bundle branch block electrocardiogram

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]

ECG

• The heart rhythm must be supraventricular in origin
• The QRS axis can be either normal, or right or left axis deviation may be present.
• The QRS duration must be = or > 120 ms
  • For complete RBBB, the patient's age must be taken into account to determine if the duration of the QRS complex is prolonged for the patient's age.
    • Maximum QRS durations are 0.07 s for newborns <6 days, 0.08 s for patients aged 1 week to 7 years, and 0.09 s for patients aged 7-15 years.
• There should be a terminal R wave in lead V1-V3R (e.g., R, rR', rsR', rSR' or qR')
  • This pattern is present because the initial R wave represents septal activation, the S wave represents left ventricular activation, and the R' represents activation of the right ventricle from the septum and left ventricle.
• There should be a slurred S wave in leads I and V6. This represent left ventricular activation.
  • Because transmission of the electrical impulse through the left bundle is normal, this results in normal depolarization of the septum and the left ventricle. As a result, there is an initial R wave in lead I and V1 and the Q wave in V6.

The T wave should be deflected opposite the terminal deflection of the QRS complex. This is known as appropriate T wave discordance with bundle branch block. A concordant T wave may suggest ischemia or myocardial infarction.

EKG Examples

The main characteristics of Right Bundle Branch Block in V1

File:ECG RBTB LAtrD.jpg Right Bundle Branch Block

Right Bundle Branch Block

Right Bundle Branch Block

Right Bundle Branch Block. Image courtesy of Dr Jose Ganseman

Right Bundle Branch Block. Image courtesy of Dr Jose Ganseman

Right Bundle Branch Block. Image courtesy of Dr Jose Ganseman

Right Bundle Branch Block. Image courtesy of Dr Jose Ganseman

Right Bundle Branch Block with first degree AV block. Image courtesy of Dr Jose Ganseman

Right Bundle Branch Block with RA hypertrophy. Image courtesy of Dr Jose Ganseman

Patient with RBBB and inferior MI. Note to left axis deviation.

The same patient. Lead V4R. ST elevation shown.

The same patient before acute MI developed. Horizontal axis shown.

Supraventricular tachycardia with RBBB. Image courtesy of Dr Jose Ganseman

Old Anterior MI with RBBB. Image courtesy of Dr Jose Ganseman

Old Inferior MI and Anterior MI with RBBB and LAFB.

Old Inferior MI and RBBB. Image courtesy of Dr Jose Ganseman

RBBB + LAFB. Image courtesy of Dr Jose Ganseman

RBBB + LAFB + First Degree AV Block. Image courtesy of Dr Jose Ganseman

RBBB + LAFB. Image courtesy of Dr Jose Ganseman

RBBB + LPFB. Image courtesy of Dr Jose Ganseman

Animation of RBBB

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