BUNDLE BRANCH BLOCK

BUNDLE BRANCH BLOCK

bundle branch block refers to a conduction block in one or both of the ventricular bundle branches FASICULAR BLOCK- only a part of one of the bundle branches is blocked

 The right and left bundle branches deliver the current to the right and left ventricles, respectively QRS complex= representing ventricular depolarization from start to finish, is narrow less than 0.10 seconds in duration muscle mass of the left ventricle is so much larger than that of the right ventricle, left ventricular electrical forces dominate those of the right ventricle, and the resultant electrical axis is leftward, lying between 0 and +90

 Thus, with normal ventricular depolarization, the QRS complex is narrow and the electrical axis lies between 0 and 90 Bundle branch block is diagnosed by looking at the width and configuration of the QRS complexes.

 Intrinsic impairment of conduction in either left or right bundle system (intraventicular conduction disturbances)--- prolongation of the QRS interval.

 COMPLETE BUNDLE BRANCH BLOCKS: QRS interval is >120ms INCOMPLETE BLOCKS: QRS interval is between 100 and 120 ms in duration

QRS VECTOR is usually oriented in the myocardial region where depolarization is delayed.

RIGHT BUNDLE BRANCH BLOCK

In right bundle branch block, conduction through the right bundle is obstructed. As a result, right ventricular depolarization is delayed; it does not begin until the left ventricle is almost fully depolarized. The terminal QRS vector is oriented to the right and anteriorly.

 The delay in right ventricular depolarization prolongs the total time for ventricular depolarization. As a result, the QRS complex widens beyond 0.12 seconds. The wide QRS complex assumes a unique, virtually diagnostic shape in those leads overlying the right ventricle: V1 and V2. the normal QRS complex in these leads consists of a small positive R wave and a deep negative S wave, reflecting the electrical dominance of the left ventricle.

 With right bundle branch block, you can still see the initial R and S waves as the left ventricle depolarizes, but as the right ventricle then begins its delayed depolarization, unopposed by the now fully depolarized and electrically silent left ventricle, the electrical axis of current flow swings sharply back toward the right. This inscribes a second R wave, called R', in leads V1 and V2. The whole complex is called RSR', Meanwhile, in the left lateral leads overlying the left ventricle (I, AVL, V5, and V6), late right ventricular depolarization causes reciprocal late deep S waves to be inscribed.

 V1& V2:rSR I, AVL, V5, and V6 : qRS

 In subjects without structural heart disease, right bundle branch block is seen more commonly than left bundle branch block. RBBB is also seen in both congenital (ASD)and acquired conditions (ischemic).