Right bundle branch block electrocardiogram

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

• 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., Rsr’, 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.

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

Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/Main_Page

Shown below is an example of an EKG showing sinus rhythm, wide QRS (>120ms.) and a markedly negative axis. There are small R waves in the inferior leads. The recording shows a right bundle branch block and a left anterior fascicular block.

Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/Main_Page

For EKG examples of right bundle branch block click here.

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