ECG. Right Bundle Branch Block (RBBB)



In case of  Right Bundle Branch Block activation of right ventricle is delayed and spreads through the septum from the left side (left ventricle). Blockade location, both in complete and partial blocks, is usually proximal.

 Main causes:
  • Pulmonary embolism
  • Chronic obstructive lung disease.
  • Ischaemic heart disease (myocardial infarction)
  • Hypertensive heart disease
  • Myocarditis
  • Cardiomyopathy
  • RBBB also can occur in normal individuals without underlying heart disease
ECG criteria:


  • QRS ≥ 0.12 seconds with mid-final slurrings;
  • V1: rsR with slurred R wave and a negative T wave (M-shaped ‘‘rabbit ear’’ pattern);
  • V6: qRs with evident S wave slurrings and positive T  wave;
  • AVR: QR with evident R wave slurrings and negative T wave;
  • T wave with its polarity opposed to QRS slurrings.


 Partial right bundle branch block.

 In this case, activation delay in the entire ventricle is less important. QRS complex duration is less than 0.12 seconds, but V1 still presents rsR or rsr  morphology, but with fewer notches and slurrings.

right bundle brunch block


(from fesmu.ru)



Examples:
  • Complete RBBB:


RBBB

  • Incomplete RBBB:

incomplete RBBB


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