Rawalpindi Medical college

1. RIGHT BUNDLE BRANCH
BLOCK
Different
presentations of
RBBB in ECG
illustrations
DR. SHAZIA

2. Normal Ventricular Conduction

Normal Conduction


fibers of LBB begin conduction
impulse travels across
interventricular septum from left to
right


travels across ventricles causing
depolarization of both
simultaneously


towards + electrode creates small r
wave
LV contributes most to complex
impulse travels away from +
electrode creates primarily
negative complex

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

5. Right Bundle Branch Block
Criteria



QRS duration ≥ 110ms
rSR’ pattern or notched R wave in V 1
Wide and slurred S wave in I and V 6

6. R-R Pattern in RBBB and LBBB

7. DIFFERENCE BETWEEN RBBB AND
LBBB

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

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

10. ECG ILLUSTERATIONS
COMPLETE RBBB

11. INCOMPLETE RBBB; rSR pattern with normal
QRS duration

12. INTERMITTANT RBBB WITH SINUS
RHYTHM

13. RBBB and LAFB

14. IDENTIFY QUESTIONS
ANS:COMPLETE RBBB

15. ANS: RBBB with left anterior fascicular block

16. ANS. INCOMPLETE RBBB

17. ANS: INTERMITTENT RBBB