Differentiating Left Bundle Branch Block Patterns Interpreting a left bundle branch block requires attention to opposite morphological changes. The left bundle branch further divides into the anterosuperior and posteroinferior fascicles, ensuring the left ventricle contracts almost simultaneously from endocardium to epicardium.
Bundle Branch Block ECG Strip Identification Tips
The classic pattern includes a broad, slurred S wave in leads I and V6, often accompanied by a tall, wide R wave, while lead V1 typically shows a deep S wave with a secondary R wave, creating an rsR' pattern commonly referred to as "bunny ears. " These findings indicate that the right ventricle is activated late, after the left ventricle has already begun its contraction, which stretches the total depolarization time.
T-wave direction opposite to the terminal deflection of the QRS in the lateral precordial leads. Key Diagnostic Criteria for Right Bundle Branch Block QRS duration greater than or equal to 120 milliseconds.
Bundle Branch Block ECG Strip Identification Tips
Secondary ST-segment and T-wave changes that oppose the main QRS deflection, often referred to as discordant repolarization. Presence of an rsR', R', or M pattern in lead V1 or V2.
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