Left Bundle Branch Blocks (LBBB)

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Since the left bundle branch accepts the electrical conduction for septal depolarization first, left bundle branch blocks are described as being a disruption in the initial depolarization of the septum. In this condition, however, the right bundle branch accepts the first wave of electrical depolarization making the electrical signal sweep right then left. The second wave of depolarization remains to the left because of the electrically dominant left ventricle.

Lead V1 - Left bundle branch blocks are represented in lead V1 by a large negative deflection, or "QS" waveform, which is usually 3-4 boxes wide and approximately 10 boxes deep. It represents septal and left ventricular depolarization. No "septal r" wave is seen because depolarization is being conducted away from lead V1 to the septum and then the left ventricle. If the complex is greater than 0.10 seconds, it represents an incomplete left bundle branch block. If the complex is greater than 0.12 seconds, it represents a complete left bundle branch block.

Lead V6 - Left bundle branch blocks are represented in lead V6 by a tall, wide, positive deflection which is usually notched and is known as an "R" waveform. If the complex is greater than 0.10 seconds, it represents an incomplete left bundle branch block. If the complex is greater than 0.12 seconds, it represents a complete left bundle branch block.


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