scholarly journals Right Bundle Branch Block: Current Considerations

2020 ◽  
Vol 16 ◽  
Author(s):  
Takanori Ikeda
Keyword(s):  
Differential Diagnosis ◽  
Clinical Practice ◽  
Electrical Activity ◽  
Right Bundle Branch Block ◽  
Qrs Complex ◽  
Bundle Branch Block ◽  
S Waves ◽  
Characteristic Appearance ◽  
Normal Sequence ◽  
Purkinje System

: RBBB, a pattern seen on the 12-lead ECG, results when normal electrical activity in the His-Purkinje system is interrupted by some reason. The normal sequence of activation is altered in RBBB, with a resultant characteristic appearance on the ECG manifest by a widened QRS complex and changes in the directional vectors of the R and S waves. This ECG pattern is often seen in clinical practice and generally regarded as benign. The anatomy, epidemiology, causes, symptoms, ECG findings and diagnosis, differential diagnosis in ECG, treatment, complications, prognosis, with respect to RBBB is outlined here, demonstrating some typical ECGs of RBBB.

Abstract P64: Right Ventricular Outflow Septal Pacing as Cardiac Resynchronization Therapy in Patients with Right Bundle-Branch Block: Results in 62 Patients

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Phillip E Schrumpf ◽  
Michael Giudici ◽  
Deborah Paul ◽  
Roselyn Krupa ◽  
Cynthia Meirbachtol
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Right Ventricular ◽  
Right Bundle Branch Block ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Qrs Complex ◽  
Resynchronization Therapy ◽  
Ventricular Performance ◽  
Bundle Branch Block ◽  
Qrs Duration

Background: Cardiac resynchronization therapy has been shown to improve left ventricular performance in patients with left ventricular dysfunction and a left-sided interventricular conduction delay. This is performed by placing a pacing lead on the lateral left ventricular wall to stimulate the area normally stimulated by the left bundle branch. In patients with right bundle branch block (RBBB), pacing the right bundle branch could also result in resynchronization. Previous studies have shown that right ventricular outflow septal (RVOS) pacing does, in fact, utilize the native conduction system. Methods: 62 consecutive patients, 46 male/16 female, aged 75 +/− 10.5 yr, with RBBB and indications for pacing, underwent RVOS lead placement using commercially available pacing systems. The patients subsequently underwent bedside A-V optimization to achieve the narrowest QRS duration and most “normal” QRS complex. Echocardiography was performed to evaluate changes in wall motion comparing baseline with optimal pacing. Results: Baseline mean QRS duration 146 +/− 20.9 ms Optimized mean QRS duration 111 +/− 20.5 ms Average decrease in QRS duration -35 +/− 21.5 ms p < 0.001 Echocardiography demonstrated improvement in septal contraction abnormalities. Conclusions: 1) RVOS pacing in RBBB patients can significantly narrow the QRS complex on ECG. 2) Septal contraction abnormalities due to RBBB can be improved with RVOS pacing and optimal A-V timing. 3) Further studies are warranted to evaluate this therapy in a heart failure population.

Stability of the ECG Features of Complete Right Bundle Branch Block over Time: A Methodological Study for Implementation in Research and Clinical Practice

Cardiology ◽  
2005 ◽  
Vol 103 (2) ◽  
pp. 84-88 ◽  
Author(s):  
John E. Madias ◽  
Ramin Ashtiani ◽  
Himanshu Agarwal ◽  
Virenjan K. Narayan ◽  
Moethu Win ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Right Bundle Branch Block ◽  
Methodological Study ◽  
Bundle Branch Block ◽  
Over Time

Abstract 16382: The Surface ECG May Provide Information About Left Ventricular Systolic Function in Patients With Right Bundle Branch Block

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Anshul Gupta ◽  
Behzad B Pavri
Keyword(s):  
Right Bundle Branch Block ◽  
Visual Recognition ◽  
Visual Analysis ◽  
Systolic Function ◽  
Left Ventricular ◽  
Lv Function ◽  
Qrs Complex ◽  
Bundle Branch Block ◽  
Transition Group ◽  
Surface Ecg

Introduction: In patients (pts) with right bundle branch block (RBBB) and heart failure, assessment of left ventricular (LV) function is vital to management, but echocardiograms (ECHO) may not always be readily available. We studied the utility of using the Superimposed Median Format (available on digital ECG systems) in assessing LV function. This format allows visual recognition of change in dV/dT when rapid initial impulse propagation over the left bundle branch (LBB) and LV Purkinje network transitions to slower muscle-to-muscle propagation to the right ventricle (RV) in the setting of RBBB. Hypothesis: With a normal LBB and healthy LV myocardium, the transition from rapid forces to slower depolarization would occur in the 1 st half of the QRS complex ( Early Transition Group - ET) whereas in patients with abnormal LV function, this transition would occur in the 2 nd half (Late Transition Group - LT) of the QRS complex. Methods: Digital superimposed median format ECGs of 108 pts with RBBB were analyzed. Pts were divided into 2 groups: ET or LT. See figure. LVEFs were obtained from ECHO. LVEF ≥ 50% was considered normal. Results: ET: n = 69. LT: n = 39. Mean QRS durations were not different in the 2 groups. ET pts were more likely to have normal LVEF (p < 0.01). See figure. PPV of ET in predicting LVEF ≥50% = 90%; NPV = 71%. Accuracy = 82%. Conclusions: These data, if confirmed, suggest that in pts with RBBB, visual analysis of the QRS complex from the surface ECG using the superimposed median format may provide valuable clues about LV systolic function, and may be clinically useful when ECHO are not readily available.

scholarly journals The Apparent and the Effective PR Interval, Insights for Cardiac Pacing

2011 ◽  
Vol 4 ◽  
pp. CCRep.S8227
Author(s):  
Antoine Kossaify
Keyword(s):  
Right Ventricular ◽  
Male Patient ◽  
Right Bundle Branch Block ◽  
Cardiac Pacing ◽  
Qrs Complex ◽  
Dual Chamber ◽  
Bundle Branch Block ◽  
Dual Chamber Pacemaker ◽  
Pr Interval ◽  
Av Delay

A 75-year-old-male patient with dual chamber pacemaker presented with a bizarre EKG showing a unique spike within the QRS complex. Apparent PR interval was 160 ms and effective atrio- right ventricular delay was 210 ms due to right bundle branch block. Sensed AV delay was set at 180 ms causing pseudofusions. Insights regarding cardiac pacing are presented.

scholarly journals COMPARATIVE ANALYSIS OF MORPHOLOGICAL CRITERIA FOR DIFFERENTIAL DIAGNOSTICS OF WIDE QRS COMPLEX ARRHYTHMIAS WITH LEFT BUNDLE BRANCH BLOCK MORPHOLOGY

2020 ◽  
Vol 26 (3) ◽  
pp. 15-28
Author(s):  
M. A. Budanova ◽  
M. P. Chmelevsky ◽  
T. V. Treshkur ◽  
V. M. Tikhonenko
Keyword(s):  
Differential Diagnosis ◽  
Transition Zone ◽  
Left Bundle Branch Block ◽  
Small Sample ◽  
Differential Diagnostics ◽  
Director General ◽  
Value Assessment ◽  
Qrs Complex ◽  
Premature Ventricular Contractions ◽  
Bundle Branch Block

Introduction. Determination of ventricular and supraventricular arrhythmias with left bundle branch block morphology (LBBB) seems to be one of the most complex diagnostic tasks when P waves are not clearly identifiable on 12-lead ECG. Previously described criteria for differential diagnosis of wide QRS arrhythmias had low accuracy especially for patients from various clinical groups and also those taking antiarrhythmic drugs. When patient’s clinical data, medical history or physical examination results are not available the number of misdiagnosis may increase leading to improper treatment. Therefore, development of new temporal and amplitude based characteristics of wide QRS complex arrhythmias with LBBB morphology in patients of any clinical groups is an important task.Methods. Twenty-eight consecutive patients with wide QRS premature beats and LBBB morphology identified by 24-hour and long-term ECG monitoring (ZAO “INCART”, Russia) were enrolled in the study. Fourteen patients had premature atrial contractions (PAC) and fourteen patients had premature ventricular contractions (PVC) during sinus rhythm. For each patient 10 typical single wide QRS complexes in 12 ECG leads were analyzed. The duration of QRS complexes, time intrinsic deflection (TID) and electrical axis of the heart were determined automatically in 12 leads ECG using KT Result 3 software (ZAO “INCART”, Russia). The experts assessed morphology of the QRS complexes and transition zone location in leads V1-V6. ROC analysis with optimal cut-off value level evaluation as well as calculation of sensitivity (SV), specificity (SP) and diagnostic accuracy (ACC) were performed for qualitative and quantitative assessment of diagnostic value of PAC and PVC amplitude and temporal characteristics. Comparison of diagnostic values of wide QRS complex morphological and temporal criteria was performed based on the AUC difference and the corresponding p-value assessment.Results. The results of study found out that V5, V1 leads were more informative for assessment of QRS complex morphology and duration while V1 and V4 leads were more informative for TID calculation in differential diagnosis of wide QRS complexes arrhythmias with LBBB morphology. PAC with aberrant conduction had the following characteristics: TID < 68 ms in V1 lead and TID < 62 ms in V4 lead; QRS < 136 ms; transition zone in the leads V5, V6; QS, rS or RS complexes (with S> R) with low-amplitude r/R waves in leads V1-V4; electric axis of the heart less than 80° in standard leads. In all cases PVCs were characterized by QRS > 160 ms and TID > 88 ms in V1-V6 leads.Conclusions. New various criteria which can improve differential diagnosis of wide QRS complexes with LBBB morphology were identified in this study. These criteria should be tested in a larger group of patients with various forms of wide QRS complex arrhythmias and different PVC localizations including information of structural heart diseases due to the small sample size in this study.Conflicts of Interest: Viktor M. Tikhonenko - CEO (Director General) of the Institute of Cardiology Technics (INCART), Saint-Petersburg, Russia.

scholarly journals Rate-related changes in QRS morphology in patients with fixed bundle branch block: implications for differential diagnosis of wide QRS complex tachycardia

2008 ◽  
Vol 29 (19) ◽  
pp. 2351-2358 ◽  
Author(s):  
T. Datino ◽  
J. Almendral ◽  
E. Gonzalez-Torrecilla ◽  
F. Atienza ◽  
F. J. Garcia-Fernandez ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Qrs Complex ◽  
Bundle Branch Block ◽  
Qrs Morphology

scholarly journals Wide QRS complex tachycardia with alternating right bundle branch block morphologies: What is the mechanism?

2020 ◽  
Vol 6 (9) ◽  
pp. 564-567
Author(s):  
Isaiah C. Lugtu ◽  
Yenn-Jiang Lin ◽  
Pi-Chang Lee ◽  
Fa-Po Chung ◽  
Shih-Ann Chen
Keyword(s):  
Right Bundle Branch Block ◽  
Qrs Complex ◽  
Bundle Branch Block

scholarly journals New ECG criteria for differential diagnosis of wide QRS complex tachycardias with right bundle branch block pattern

2019 ◽  
Vol 91 (4) ◽  
pp. 83-89 ◽  
Author(s):  
N B Shlevkov ◽  
H F Salami ◽  
V G Kiktev ◽  
S F Sokolov
Keyword(s):  
Differential Diagnosis ◽  
Right Bundle Branch Block ◽  
S Wave ◽  
Bundle Branch Block ◽  
Prognostic Accuracy ◽  
Electrophysiological Studies ◽  
Block Pattern ◽  
Ecg Criteria ◽  
Ventricular Tachycardias ◽  
Supraventricular Tachycardias

Aim. To evaluate standard 12-lead ECG indices for the differential diagnosis of wide QRS tachycardias with right bundle branch block (RBBB) pattern. Materials and methods. Study analyses the 244 ECG indices in 111 patients (79 males and 32 females, age 53±17 years) with RBBB tachycardias, who underwent electrophysiological studies. First step includes retrospective analysis of QRS characteristics in 20 patients with ventricular tachycardias (VT), 24 pts with aberrant supraventricular tachycardias (SVT+RBBB) and 14 pts with antidromic SVTs (WPW). ROC- and multifactorial analyses were performed to develop diagnostic ECG algorithms. The prognostic accuracy of the algorithms was subsequently evaluated on a prospective group of patients with RBBB tachycardias (n=53). Results and discussion. ECG criteria of RBBB VTs were: 1) the presence Q-wave in lead II, 2) the duration interval R(peak)-S(end) >100 ms in lead V5. ECG criteria for antidromic SVTs with RBBB were: 1) the duration of the R wave in lead I ≥80 ms, 2) the absence of split (M-sharp) R-waves in lead V2, 3) the absence notch in ascending S wave in lead aVL. The accuracy of the algorhythm for diagnostic of VTs with RBBB was 83% (sensitivity 100%, specificity 73%). The accuracy of the algorhythm for diagnostic of antidromic SVTs with RBBB was 91% (sensitivity 85%, specificity 96%). Conclusion. The proposed algorithms are based on new ECG criteria for the differential diagnosis of wide QRS complexes tachycardias with RBBB pattern, unlike the previous algorithms.

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