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Bundle Branch Blocks

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  1. Bundle Branch Blocks J. Huffman, PGY-4 July 2, 2009

  2. Outline • LBBB • RBBB • Hemiblock • PRACTICE!

  3. Physiologically On ECG Unblocked ventricle R R’ Blocked ventricle Two QRS’s out of ‘sync’ Single, wide QRS

  4. LBBB

  5. RBBB

  6. RBBB

  7. RBBB

  8. LBBB

  9. LBBB

  10. “WiLLiaM MoRRoW”

  11. LBBB

  12. LBBB

  13. ECG Changes: • Hemiblock (unlike a full LBBB or RBBB) does not widen the QRS complex. • Main effect is a change in the QRS axis:  Left anterior fascicular block results in marked left axis deviation (-30° or more) QISIII pattern  Left posterior fascicular block produces marked right axis deviation (+120° or more) SIQIII pattern

  14. Anterior Hemiblock aVL I III II Posterior Hemiblock aVF

  15. Axis? Between -30 and -90 deg  LAD

  16. Anterior Fascicular Block

  17. Posterior Fascicular Block

  18. LAFB

  19. Bifascicular Block (RBBB & LAFB)

  20. RBBB + LAFB

  21. Trifascicular Block(RBBB + LAFB + 1° AV block)

  22. V1 & V2 have the best “view” of the RV • V5 & V6 look at the LV • Look for the RR’ pattern in those pairs of leads • Incomplete = <120ms but meets morphology criteria • Hemiblocks: look at the axis!

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