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Bundle Branch Block

Aka: Bundle Branch Block, Left Bundle Branch Block, Right Bundle Branch Block, Left Anterior Hemiblock, Left Posterior Hemiblock, LBBB, RBBB
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  1. Background
    1. Normal bundle branch transmission
      1. Following AV node and His Bundle, signal divides into the left and right bundles
      2. Results normally in a simultaneous depolarization of each ventricle
    2. Bundle Branch Block
      1. Electrical impulse blocked in the left bundle branch or right bundle branch
      2. Results in a depolarization delay of the affected ventricle
      3. Results in overall widening of the QRS Complex (0.12 or greater meets criteria for BBB)
        1. Left and right bundles signals are separated in time (no longer simultaneous or overlapped)
        2. Shape of QRS is also modified to have two R Waves, with the delayed R Wave referred to as R'
      4. QRS Axis and ventricular hypertrophy are not accurately determined in Bundle Branch Block
        1. Normally each ventricle's depolarization signal is simultaneous and opposes the other
        2. In Bundle Branch Block, these signals are offset resulting in large deflections (positive or negative)
    3. Right Bundle Branch Block
      1. Left ventricle (R) depolarizes before the right ventricle (R')
      2. Best seen in the right sided precordial leads (V1, V2) with characteristic 'M' appearance
    4. Left Bundle Branch Block
      1. Right ventricle (R) depolarizes before the left ventricle (R')
      2. Best seen in the left sided precordial leads (V5, V6) with a concave upward plateau to the top of the QRS Complex
      3. Q Waves absent
        1. Delay in left ventricular depolarization with right ventricle firing first
        2. Q waves are not seen as the negative depolarization falls in the middle of wide QRS Complex
    5. Incomplete Bundle Branch Block
      1. Pattern of R and R' seen in a patient with a QRS Complex duration less than 0.12 seconds
    6. Critical Rate
      1. Rate at which Bundle Branch Block is seen (may not be evident at slower rates)
    7. Aberrant Conduction
      1. May mimic Bundle Branch Block
      2. Results from a discrepancy between the refractory periods between each ventricle
        1. Refractory period is time in ventricle following depolarization where it will not respond to a new depolarization signal
        2. Refractory periods may be slightly different between the ventricles
        3. At rapid rates, one ventricles depolarization may be delayed (offset) from the other giving the appearance of Bundle Branch Block
  2. Findings: Left Bundle Branch Block
    1. EKG findings
      1. Lead V1
        1. QS or rS
      2. Lead V6
        1. Late intrinsicoid deflection
        2. No Q wave
        3. Monophasic R Wave
      3. Lead I
        1. Monophasic R Wave
        2. No Q wave
    2. Causes
      1. Chronic Ischemic Heart Disease
      2. Chronic Hypertension (with Left Ventricular Hypertrophy)
      3. Chronic Congestive Heart Failure (abnormal ventricular remodeling)
      4. Valvular heart disease
      5. Old age with a fibrotic conduction system
      6. Massive acute Myocardial Infarction
        1. See New Left Bundle Branch Block
        2. See Sgarbossa Criteria
    3. References
      1. Mattu and Herbert in Majoewksy (2012) EM:Rap 12(11): 4
  3. Findings: Right Bundle Branch Block EKG
    1. Lead V1
      1. Late Intrinsicoid Deflection
      2. M-shaped QRS Complex
      3. Wide R Wave or qR (occasionally)
    2. Lead V6
      1. Early Intrinsicoid Deflection
      2. Wide S wave
    3. Lead I
      1. Wide S wave
  4. Findings: Left Anterior Hemiblock EKG
    1. Left Axis Deviation (beyond -60 degrees)
    2. Small Q wave in Lead I
    3. Small R Wave in Lead III
    4. Normal QRS Duration
    5. No Right Ventricular Hypertrophy
  5. Findings: Left Posterior Hemiblock EKG
    1. Right Axis Deviation (beyond +120 degrees)
    2. Small R Wave in Lead I
    3. Small Q wave in Lead III
    4. Normal QRS Duration
    5. No Right Ventricular Hypertrophy
  6. References
    1. Dubin (1974) Rapid Interpretation of EKGs, COVER publishing, Tampa, p. 137-47

Bundle-Branch Block (C0006384)

Definition (NCI) An electrocardiographic finding defined by prolongation of the QRS complex. It is caused by damage of one of the bundle branches, resulting in the delay or obstruction of the conduction of electrical impulses.
Definition (MSH) A form of heart block in which the electrical stimulation of HEART VENTRICLES is interrupted at either one of the branches of BUNDLE OF HIS thus preventing the simultaneous depolarization of the two ventricles.
Concepts Disease or Syndrome (T047)
MSH D002037
ICD9 426.50
ICD10 I45.4
SnomedCT 251122006, 195048003, 6374002
English Block, Bundle-Branch, Blocks, Bundle-Branch, Bundle-Branch Blocks, BLOCK BUNDLE BRANCH, BUNDLE BRANCH BLOCK, Bundle-branch block, HEART BLOCK BUNDLE BRANCH, Bundle branch block, NOS, Bundle branch block unspecif., Bundle branch block unspecified, Bundle branch block, unspecified, Bundle-Branch Block, bundle branch block (diagnosis), bundle branch block, BBB (bundle branch block), Block bundle branch, Bundle branch block NOS, Heart block bundle branch, Bundle branch block unspecified (disorder), Bundle Branch Block, Bundle-branch block NOS, Bundle-Branch Block [Disease/Finding], Block;bundle branch, bundle block branch, bundle branch heart block, bundle-branch block, block branch bundle heart, block bundle branch, branch bundle block, block branch bundle, blocks branch bundle, blocked branch bundle, Bundle branch block, BBB - Bundle branch block, Bundle branch block (disorder), block; bundle-branch, bundle-branch; block
French BLOC DE BRANCHE, Bloc de branche non précisé, Bloc de branche SAI, Bloc de branches, Bloc de branche
Portuguese BLOQUEIO DE RAMO, Bloqueio de ramo NE, Bloqueio de ramo cardíaco, Bloqueio de ramo, Bloqueio do tronco, Bloqueio de Ramo
Spanish BLOQUEO DE RAMA, Bloqueo de rama NEOM, Bloqueo de rama no especificada, Bloqueo cardiaco de rama, Bundle branch block, bloqueo de rama (trastorno), bloqueo de rama del haz de His, bloqueo de rama no especificado (trastorno), bloqueo de rama no especificado, bloqueo de rama, Bloqueo de rama, Bloqueo de Rama
Dutch bundeltakhartblok, bundeltakblok NAO, bundeltakblok, niet-gespecificeerd, block; bundeltak, bundeltak; block, bundeltakblok, Blok, bundeltak-, Bundeltakblok
German Herzschenkelblock, Schenkelblock, unspezifisch, Schenkelblock NNB, HERZSCHENKELBLOCK, Schenkelblock
Italian Blocco di branca NAS, Blocco cardiaco di branca, Altro e non specificato blocco di branca, Blocco di branca
Japanese 脚ブロック、詳細不明, 脚ブロックＮＯＳ, ｷｬｸﾌﾞﾛｯｸNOS, ｷｬｸﾌﾞﾛｯｸｼｮｳｻｲﾌﾒｲ, ｷｬｸﾌﾞﾛｯｸ, 束ブロック, 脚ブロック
Swedish Grenblock
Czech blokáda Tawarova raménka, Raménková blokáda, Blokáda raménka, Blokáda raménka, blíže neurčená, Srdeční raménková blokáda, Blokáda raménka NOS
Finnish Haarakatkos
Russian PUCHKA GISA NOZHEK BLOKADA, FASTSIKULIARNAIA BLOKADA, ПУЧКА ГИСА НОЖЕК БЛОКАДА, ФАСЦИКУЛЯРНАЯ БЛОКАДА
Croatian BLOK BRANE HISOVOG SKLOPA
Polish Blok pęczka Hisa, Blok odnogi pęczka Hisa
Hungarian Tawara-szár block k.m.n., Tawara-szár block, nem meghatározott, Tawara-szár block, Tawara - szár block, Szívblock, Tawara-szár
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Left Bundle-Branch Block (C0023211)

Definition (NCI) An impairment of transmission of the cardiac electrical impulse along the fibers of the left main bundle branch, or both the left anterior fascicle and left posterior fascicle. This conduction disturbance is characterized by wide (greater than 0.11s) QRS complexes. The diagnostic criteria consist of prolongation of the QRS complexes (over 0.11s) with neither a Q wave nor an S wave in lead V1 and in the properly placed V6. A wide R wave with a notch on its top (plateau) is seen in these leads. In hearts with an electrical (and anatomic) vertical position a small Q wave may be seen in AVL in the absence of MI. Right chest lead V1 may or may not show an initial R wave, but the latter should be present in lead V2. (NCI)
Definition (NCI) An impairment of transmission of the cardiac electrical impulse along the fibers of the left main bundle branch, or both the left anterior fascicle and left posterior fascicle. This conduction disturbance is characterized by wide (greater than 0.11s) QRS complexes. The diagnostic criteria consist of prolongation of the QRS complexes (over 0.11s) with neither a Q wave nor an S wave in lead V1 and in the "properly placed" V6. A wide R wave with a notch on its top ("plateau") is seen in these leads. In hearts with an electrical (and anatomic) vertical position a small Q wave may be seen in AVL in the absence of MI. Right chest lead V1 may or may not show an initial R wave, but the latter should be present in lead V2.
Concepts Disease or Syndrome (T047)
MSH D002037
ICD10 I44.7
SnomedCT 155357007, 63467002, 195044001
English BUNDLE BRANCH BLOCK, LEFT, LBBB, Left bundle branch block, NOS, LBBB - L bundle branch block, Left bundle-branch block, unspecified, BUNDLE BRANCH BLOCK LEFT, Left Bundle Branch Block, Bundle-Branch Blocks, Left, Block, Left Bundle-Branch, Blocks, Left Bundle-Branch, Left Bundle-Branch Blocks, Bundle-Branch Block, Left, lbbb, left bundle branch block, left bundle branch block (diagnosis), LBBB (left bundle branch block), LEFT BUNDLE BRANCH BLOCK, Left Bundle-Branch Block, Bundle branch block left, blocks branch bundle left, Block;bundle branch;left, bundle branch block left, blocked branch bundle left, left bundle-branch block, block branch bundle left, left branch bundle block, Left bundle branch block, LBBB - Left bundle branch block, Left bundle branch block (disorder), block; bundle-branch, left, Left bundle branch block NOS
Italian Blocco di branca sinistra, Blocco di branca sinistro
Dutch linkerbundeltakblok, LBBB, block; bundeltak, linker, Linker-bundeltakblock, niet gespecificeerd, bundeltakblok links
French Bloc de la branche gauche, BBG, Bloc de branche gauche, BLOC DE BRANCHE GAUCHE
German LBBB, Linksschenkelblock, Linksschenkelblock, nicht naeher bezeichnet
Spanish BRI, Left bundle branch block, bloqueo de la rama izquierda del haz de His (trastorno), bloqueo de la rama izquierda del haz de His, Bloqueo de rama izquierda
Japanese 左脚ブロック, ｻｷｬｸﾌﾞﾛｯｸ
Portuguese BLOQUEIO DE RAMO ESQUERDO, Bloqueio de ramo esquerdo
Czech Blokáda levého Tawarova raménka, blokáda levého raménka Tawarova, blokáda levého Tawarova raménka, LBBB, BLRT
Korean 상세불명의 좌각 차단
Hungarian LBBB, Bal Tawara-szár block
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Right bundle branch block (C0085615)

Definition (NCI) An impairment of transmission of the cardiac electrical impulse along the fibers of the right bundle branch. A " complete RBBB pattern" (with QRS duration > 0.11s) does not necessarily reflect the existence of a total conduction block in the right branch. This pattern only indicates that the entire or major parts of both ventricles are activated by the impulse emerging from the left branch. Thus, a significant degree of conduction delay ("high-grade" or "incomplete RBBB") can produce a similar pattern.
Definition (NCI) An impairment of transmission of the cardiac electrical impulse along the fibers of the right bundle branch. A "complete RBBB pattern" (with QRS duration > 0.11s) does not necessarily reflect the existence of a total conduction block in the right branch. This pattern only indicates that the entire or major parts of both ventricles are activated by the impulse emerging from the left branch. Thus, a significant degree of conduction delay ("high-grade" or "incomplete RBBB") can produce a similar pattern. (NCI)
Concepts Disease or Syndrome (T047)
MSH D002037
ICD9 426.4
ICD10 I45.0, I45.10
SnomedCT 155358002, 195064006, 195055001, 59118001
English BUNDLE BRANCH BLOCK, RIGHT, RBBB, RBBB - Rt bundle branch block, BUNDLE BRANCH BLOCK RIGHT, Right Bundle Branch Block, Right Bundle-Branch Block, Block, Right Bundle-Branch, Bundle-Branch Blocks, Right, Blocks, Right Bundle-Branch, Bundle-Branch Block, Right, Right Bundle-Branch Blocks, rbbb, right bundle branch block, right bundle branch block (diagnosis), RBBB (right bundle branch block), RIGHT BUNDLE BRANCH BLOCK, Right bundle branch block, Bundle branch block right, Rt bundle branch block, Right bundle-branch block NOS, blocked branch bundle right, Block;bundle branch;right, blocks branch bundle right, right branch bundle block, RBBB - Right bundle branch block, Right fascicular block, Right bundle branch block (disorder), block; bundle-branch, right, block; fascicular, right, bundle-branch; block, right, fascicular, bundle-branch; block, right, fascicular; block, right
Italian Blocco di branca destra, Blocco di branca destro, Blocco completo di branca destra
Dutch rechterbundeltakblok, RBTB, block; bundeltak, rechter, block; fasciculair, rechter, bundeltak; block, rechter, fasciculair, bundeltak; block, rechter, fasciculair; block, rechter, Rechter fasciculair block, bundeltakblok rechts
French Bloc de la branche droite, BBD, Bloc de branche droit, BLOC DE BRANCHE DROIT
German RBBB, Rechtsschenkelblock, Rechtsfaszikulaerer Block
Spanish BRD, Right bundle branch block, bloqueo de la rama derecha del haz de His (trastorno), bloqueo de la rama derecha del haz de His, hemibloqueo ventricular derecho, Bloqueo de rama derecha
Japanese 右脚ブロック, ｳｷｬｸﾌﾞﾛｯｸ
Portuguese BLOQUEIO DE RAMO DIREITO, Bloqueio de ramo direito
Czech Blokáda pravého Tawarova raménka, Blok pravého raménka, blokáda pravého Tawarova raménka, BPRT, RBBB, blokáda pravého raménka Tawarova
Korean 우 섬유속 차단
Hungarian Jobb Tawara szár block, Jobb Tawara-szár block, RBBB
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Left anterior fascicular block (C0264912)

Definition (NCI) An impairment of transmission of the cardiac electrical impulse along the fibers of the left anterior fascicle. In left anterior fascicular block (LAFB) the posteroinferior regions of the left ventricular endocardium are activated abnormally before the anterosuperior left ventricular area. After emerging from the posteroinferior division of the left bundle branch, the impulse first propagates in an inferior, rightward, and usually anterior direction for a short period of time. This orientation is responsible for the small Q waves in leads 1 and aVL and for the R waves in leads II, III, and aVF. (NCI)
Definition (NCI) An impairment of transmission of the cardiac electrical impulse along the fibers of the left anterior fascicle. In left anterior fascicular block (LAFB) the posteroinferior regions of the left ventricular endocardium are activated abnormally before the anterosuperior left ventricular area. After emerging from the posteroinferior division of the left bundle branch, the impulse first propagates in an inferior, rightward, and usually anterior direction for a short period of time. This orientation is responsible for the small q waves in leads I and aVL and for the r waves in leads II, III, and aVF.
Concepts Disease or Syndrome (T047)
ICD10 I44.4
SnomedCT 37760005
English Left anterior fascicular block, LAFB - Left ant fascicul block, LAFB, Left Anterior Hemiblock, Left Anterior Fascicular Block, left anterior block bundle branch hemiblock (diagnosis), left anterior block bundle branch hemiblock, LBBB anterior hemiblock, LEFT ANTERIOR FASCICULAR BLOCK, left anterior fascicular block, anterior block fascicular left, LAFB - Left anterior fascicular block, Left anterior fascicular block (disorder), block; bundle-branch, left, fascicular, anterior, bundle-branch; block, left, fascicular, anterior, fascicular; block, left, anterior, Block, left anterior fascicular
Dutch linker voorste fasciculair blok, block; bundeltak, linker, fasciculair, anterior, bundeltak; block, linker, fasciculair, anterior, fasciculair; block, linker, anterior, Linker anterior fasciculair block
French Bloc fasciculaire antérieur gauche
German linksanteriorer Hemiblock, Linksanteriorer Faszikelblock
Italian Blocco fascicolare anteriore sinistro
Portuguese Bloqueio fascicular anterior esquerdo
Spanish Bloqueo fascicular izquierdo anterior, bloqueo de la rama izquierda anterior del haz de His (trastorno), bloqueo de la rama izquierda anterior del haz de His, bloqueo fascicular izquierdo anterior, hemibloqueo anterior izquierdo
Japanese 左脚前枝ブロック, ｻｷｬｸｾﾞﾝｼﾌﾞﾛｯｸ
Czech Levý přední fascikulární blok
Korean 좌전 섬유속 차단
Hungarian Bal anterior fascicularis block
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Left posterior fascicular block (C0264913)

Definition (NCI) An impairment of transmission of the cardiac electrical impulse along the fibers of the left posterior fascicle. In pure left posterior fascicular block (LPFB), the impulse emerges from the unblocked anterosuperior division, thus producing small q waves in leads II, III, and aVF. Thereafter, the impulse moves through the electrically predominant left ventricle in an inferior and rightward direction, thus explaining the S waves in leads I and aVL as well as the R waves in leads II, III, and aVF. (NCI)
Definition (NCI) An impairment of transmission of the cardiac electrical impulse along the fibers of the left posterior fascicle. In pure left posterior fascicular block (LPFB), the impulse emerges from the unblocked anterosuperior division, thus producing small q waves in leads II, III, and aVF. Thereafter, the impulse moves through the electrically predominant left ventricle in an inferior and rightward direction, thus explaining the S waves in leads I and aVL as well as the R waves in leads II, III, and aVF.
Concepts Disease or Syndrome (T047)
ICD10 I44.5
SnomedCT 62026008
English Left post fascicular block, Left posterior hemiblock, Left Posterior Hemiblock, LPFB, Left Posterior Fascicular Block, left posterior bundle branch hemiblock, LBBB posterior hemiblock, left posterior bundle branch hemiblock (diagnosis), LEFT POSTERIOR FASCICULAR BLOCK, Left posterior fascicular block, Left posterior fascicular block (disorder), block; bundle-branch, left, fascicular, posterior, bundle-branch; block, left, fascicular, posterior, fascicular; block, left, posterior, Block, left posterior fascicular
Dutch linkerachterste hemiblok, linker posterior fasciculair blok, block; bundeltak, linker, fasciculair, posterior, bundeltak; block, linker, fasciculair, posterior, fasciculair; block, linker, posterior, Linker posterior fasciculair block
French Hémibloc postérieur gauche, Bloc fasciculaire postérieur gauche
German linksposteriorer Hemiblock, Linksposteriorer Faszikelblock, Linksposteriorer faszikulaerer Block
Italian Emiblocco posteriore sinistro, Blocco fascicolare posteriore sinistro
Portuguese Hemibloqueio posterior esquerdo, Bloqueio fascicular posterior esquerdo
Spanish Hemibloqueo posterior izquierdo, Bloqueo fascicular izquierdo posterior, bloqueo de la rama izquierda posterior del haz de His (trastorno), bloqueo de la rama izquierda posterior del haz de His, bloqueo fascicular izquierdo posterior, hemibloqueo posterior izquierdo
Japanese 左脚後枝ヘミブロック, ｻｷｬｸｺｳｼﾍﾐﾌﾞﾛｯｸ, 左脚後枝ブロック, ｻｷｬｸｺｳｼﾌﾞﾛｯｸ
Czech Levý zadní hemiblok
Korean 좌후 섬유속 차단
Hungarian Bal posterior fascicularis block, Bal hátulsó hemiblock
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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