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12 Lead ECG Basics Bundle Branch Block

12 Lead ECG Basics Bundle Branch Block. Left Bundle Branch Block (LBBB)Complete" LBBB" has a QRS duration >0.12s

MikeCarlo
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12 Lead ECG Basics Bundle Branch Block

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    1. 12 Lead ECG Basics Bundle Branch Block Right Bundle Branch Block (RBBB): "Complete" RBBB has a QRS duration >0.12s Close examination of QRS complex in various leads reveals that the terminal forces (i.e., 2nd half of QRS) are oriented rightward and anteriorly because the right ventricle is depolarized after the left ventricle. Terminal R' wave in lead V1 (usually see rSR' complex) indicating late anterior forces

    2. 12 Lead ECG Basics Bundle Branch Block Left Bundle Branch Block (LBBB) Complete" LBBB" has a QRS duration >0.12s  Close examination of QRS complex in various leads reveals that the terminal forces (i.e., 2nd half of QRS) are oriented leftward and posteriorly because the left ventricle is depolarized after the right ventricle.  Terminal S waves in lead V1 indicating late posterior forces

    3. 12 Lead ECG Basics Bundle Branch Block Using the Turn Signal Method for BBB Determination   Since in both LBBB and RBBB the conduction delay will appear at the end of the QRS in V1,,,we can apply the turn signal method for determining the blocked bundle branch. To use this method follow the steps listed in the next slides.  

    4. 12 Lead ECG Basics Bundle Branch Block Step 1. Determine that the rhythm is supraventricular in origin and has a QRS that is > 0.12 secs in lead V1 or MCL1 .  Step 2. Locate the J point in the ECG cycle (end of the QRS and beginning of the ST).  Step 3. Draw a line backward into the terminal component of the QRS.  Step 4. Shade in the triangle created by this line and the terminal component of the QRS.  

    5. 12 Lead ECG Basics Bundle Branch Block The turn signal method works on the same premise as the turn signal in your car. The turn signal arm is flicked up to activate the blinker for a right hand turn. Similarly, when the triangle points upright it is a RBBB. When the turn signal arm is pushed down it indicates a left turn. Similarly, when the triangle the triangle points down it is a LBBB.

    6. 12 Lead ECG Basics Bundle Branch Block Step 5. If the triangle points up then it is a Right BBB.  

    7. 12 Lead ECG Basics Bundle Branch Block Step 6. If the triangle points down then it is a Left BBB.

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