This document discusses right bundle branch block (RBBB) in the electrocardiogram (ECG). It begins by explaining normal ventricular conduction, then describes RBBB. Key points of RBBB include a QRS duration of over 110ms, an rSR' pattern or notched R wave in lead V1, and a wide and slurred S wave in leads I and V6. The document contrasts RBBB and left bundle branch block (LBBB) and provides illustrations of complete RBBB, incomplete RBBB, intermittent RBBB, and RBBB with left anterior fascicular block. It emphasizes using lead V1 and the direction of the terminal QRS force (upward for RBBB, downward for LBBB)

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