Right bundle branch block electrocardiogram

Right bundle branch block Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Right bundle branch block from other Diseases
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
EKG Examples
Echocardiography
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Right bundle branch block electrocardiogram On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Right bundle branch block electrocardiogram All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Right bundle branch block electrocardiogram
CDC on Right bundle branch block electrocardiogram
Right bundle branch block electrocardiogram in the news
Blogs on Right bundle branch block electrocardiogram
Directions to Hospitals Treating Right bundle branch block
Risk calculators and risk factors for Right bundle branch block electrocardiogram

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

Overview

Criteria for complete right bundle branch block includes: a QRS duration of > .12 seconds, a rSR' pattern with a wide terminal R wave in V1 and a qRS complex with a wide S wave in V6.

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.

---

Below is an electrocardiogram showing the main characteristics of right bundle branch block on lead V1.

---

The rhythm is sinus. The QRS is wide (>120ms.) and the axis is markedly negative. There are small R waves in the inferior leads. The recording shows a right bundle branch block and a left anterior fasicular block.

---

For EKG examples of right bundle branch block click here.

Animation of RBBB

{{#ev:youtube|EJUQKaDeAXg}}