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A right bundle branch block (RBBB) is a heart block in the right bundle branch of the electrical conduction system. [1] During a right bundle branch block, the right ventricle is not directly activated by impulses traveling through the right bundle branch. However, the left bundle branch still normally activates the left ventricle.
Bifascicular block is a combination of right bundle branch block and either left anterior fascicular block or left posterior fascicular block. Conduction to the ventricle would therefore be via the remaining fascicle. The ECG will show typical features of RBBB plus either left or right axis deviation. [7] [8]
A right bundle branch block typically causes prolongation of the last part of the QRS complex and may shift the heart's electrical axis slightly to the right. The ECG will show a terminal R wave in lead V1 and a slurred S wave in lead I. Left bundle branch block widens the entire QRS, and in most cases shifts the heart's electrical axis to the ...
So with right bundle branch block, the right ventricle contracts late. If the block happened to be on the left side instead, a left bundle branch block, the signal would be delayed on that side and so the right ventricle would contract first, and then the left ventricle would contract late.
Overall, the diagnoses are made based on the patterns. For example, an "irregularly irregular" QRS complex without P waves is the hallmark of atrial fibrillation; however, other findings can be present as well, such as a bundle branch block that alters the shape of the QRS complexes.
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Intraventricular conduction delay seen in precordial/chest leads with QRS duration 100 ms. An EKG of a 25-year-old male. Intraventricular conduction delays (IVCD) are conduction disorders seen in intraventricular propagation of supraventricular impulses resulting in changes in the QRS complex duration or morphology, or both.