Materiały źródłowe

• #1 Bundle branch block – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bundle-branch-block/diagnosis-treatment/drc-20370518

  If you have a right bundle branch block and you’re otherwise healthy, you might not need a full medical checkup. If you have a left bundle branch block, you will need a thorough medical exam. […] Tests that can be used to diagnose a bundle branch block or its causes include: […] Electrocardiogram (ECG or EKG). This quick and painless test measures the electrical activity of the heart. During an electrocardiogram (ECG), sensors (electrodes) are attached to the chest and sometimes to the arms or legs. An can show how well the heart is beating. It can show signs of a bundle branch block, as well as which side of the heart is being affected. […] Echocardiogram. This test uses sound waves to provide detailed images of the heart and heart valves. It can show the structure and the thickness of the heart muscle. Your provider can use this test to pinpoint a condition that caused the bundle branch block.

• #2 Bundle Branch Block: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/22938-bundle-branch-block

  A bundle branch block (BBB) is a block or disruption to the electrical impulse that contracts your hearts lower chambers. […] Healthcare providers diagnose BBB with two main tests: Electrocardiogram (EKG) and Echocardiogram. […] An EKG can also show which side of your heart has the bundle branch block. […] If your provider diagnoses you with BBB, they will check you for related health conditions. […] If you have symptoms such as fainting, your provider may suggest a pacemaker. […] A diagnosis of left bundle branch block often means that you have an underlying heart condition. […] Providers usually diagnose BBB with an EKG or echocardiogram.

• #3 Bundle Branch Block: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/22938-bundle-branch-block

  A bundle branch block (BBB) is a block or disruption to the electrical impulse that contracts your hearts lower chambers. […] Healthcare providers diagnose BBB with two main tests: Electrocardiogram (EKG) and Echocardiogram. […] An EKG can also show which side of your heart has the bundle branch block. […] If your provider diagnoses you with BBB, they will check you for related health conditions. […] If you have symptoms such as fainting, your provider may suggest a pacemaker. […] A diagnosis of left bundle branch block often means that you have an underlying heart condition. […] Providers usually diagnose BBB with an EKG or echocardiogram.

• #4 Bundle Branch Block | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/b/bundle-branch-block.html

  A bundle branch block is usually diagnosed with an electrocardiogram. Your doctor also may want to test the health and function of your lung. Testing may also include blood work. […] Usually no treatment is done for bundle branch blocks directly. Your doctor may address the heart disease, if it is present.

• #5 Bundle branch block – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bundle-branch-block/diagnosis-treatment/drc-20370518

  If you have a right bundle branch block and you’re otherwise healthy, you might not need a full medical checkup. If you have a left bundle branch block, you will need a thorough medical exam. […] Tests that can be used to diagnose a bundle branch block or its causes include: […] Electrocardiogram (ECG or EKG). This quick and painless test measures the electrical activity of the heart. During an electrocardiogram (ECG), sensors (electrodes) are attached to the chest and sometimes to the arms or legs. An can show how well the heart is beating. It can show signs of a bundle branch block, as well as which side of the heart is being affected. […] Echocardiogram. This test uses sound waves to provide detailed images of the heart and heart valves. It can show the structure and the thickness of the heart muscle. Your provider can use this test to pinpoint a condition that caused the bundle branch block.

• #6 Right Bundle Branch Block: Symptoms, Causes, Diagnosis, Treatment

  https://www.healthline.com/health/right-bundle-branch-block

  Right bundle branch block (RBBB) is a slowing of electrical impulses to the hearts right ventricle. […] Doctors usually diagnose RBBB by using an electrocardiogram. This is a painless test that involves placing stickers called leads around your chest. The leads conduct electricity. Theyre connected to wires that sense the electrical impulses of your heart and trace your hearts rhythm. […] Sometimes, a bundle branch block makes it harder for doctors to diagnose other heart conditions, like heart failure or enlargement. If youve been diagnosed with RBBB, make sure to tell any other doctors you see that you have one.

• #7 Bundle branch block – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bundle-branch-block/diagnosis-treatment/drc-20370518

  If you have a right bundle branch block and you’re otherwise healthy, you might not need a full medical checkup. If you have a left bundle branch block, you will need a thorough medical exam. […] Tests that can be used to diagnose a bundle branch block or its causes include: […] Electrocardiogram (ECG or EKG). This quick and painless test measures the electrical activity of the heart. During an electrocardiogram (ECG), sensors (electrodes) are attached to the chest and sometimes to the arms or legs. An can show how well the heart is beating. It can show signs of a bundle branch block, as well as which side of the heart is being affected. […] Echocardiogram. This test uses sound waves to provide detailed images of the heart and heart valves. It can show the structure and the thickness of the heart muscle. Your provider can use this test to pinpoint a condition that caused the bundle branch block.

• #8 Left Bundle Branch Block: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/23287-left-bundle-branch-block

  Left bundle branch block (LBBB) occurs when something blocks or disrupts the electrical impulse that causes your heart to beat. This block leads to an abnormal heart rhythm. A diagnosis of left bundle branch block often means that you have an underlying heart condition. […] Healthcare providers diagnose this condition with an electrocardiogram (EKG). During an EKG, your provider attaches electrodes to the skin of your chest. You lie still while a computer records an image of electrical impulses that travel through your heart. […] If your provider diagnoses you with left bundle branch block, they will check you for other health conditions related to LBBB. They may recommend the following tests: Blood pressure reading to look for high or low blood pressure. Blood test to check cholesterol levels. Echocardiogram to examine blood flow in your heart and check for heart disease. Nuclear cardiac stress test to look for coronary artery disease.

• #9 Bundle Branch Block: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/22938-bundle-branch-block

  A bundle branch block (BBB) is a block or disruption to the electrical impulse that contracts your hearts lower chambers. […] Healthcare providers diagnose BBB with two main tests: Electrocardiogram (EKG) and Echocardiogram. […] An EKG can also show which side of your heart has the bundle branch block. […] If your provider diagnoses you with BBB, they will check you for related health conditions. […] If you have symptoms such as fainting, your provider may suggest a pacemaker. […] A diagnosis of left bundle branch block often means that you have an underlying heart condition. […] Providers usually diagnose BBB with an EKG or echocardiogram.

• #10 Left Bundle Branch Block – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482167/

  According to the American College of Cardiology, American Heart Association, and Heart Rhythm Society, complete LBBB is defined by the following ECG features: QRS duration greater than or equal to 120 ms. […] The European Society of Cardiology provided the following criteria for diagnosis of LBBB in 2021: QRS duration greater than or equal to 120 ms. […] A TTE is warranted for further evaluation of underlying structural heart disease in these individuals. […] The ECG tracing should be evaluated thoroughly to confirm the presence of LBBB based on known criteria. […] The presence of LBBB post-TAVR can increase the risk of developing high-grade atrioventricular block, requiring permanent pacemaker implantation. […] Patients with isolated, asymptomatic LBBB without other conduction disturbances may not require immediate pacemaker implantation.

• #11 Left Bundle Branch Block (LBBB) • LITFL • ECG Library Diagnosis

  https://litfl.com/left-bundle-branch-block-lbbb-ecg-library/

  QRS duration 120ms […] In LBBB, conduction delay means that impulses travel first via the right bundle branch to the RV, and then to the LV via the septum […] The delay between activation of the RV and LV produces the characteristic M-shaped R wave seen in lateral leads […] Delayed overall conduction time to the LV extends the QRS duration to 120 ms […] Incomplete LBBB is diagnosed when typical LBBB morphology is associated with a QRS duration 120ms.

• #12 Left Bundle Branch Block (LBBB) ECG Review

  https://www.healio.com/cardiology/learn-the-heart/ecg-review/ecg-topic-reviews-and-criteria/left-bundle-branch-block-lbbb-review

  The ECG criteria for a left bundle branch block include: […] A simple way to diagnose a left bundle branch in an ECG with a widened QRS complex (120 ms) would be to look at lead V1. […] Note: If the QRS duration is 100 to 119 ms with criteria 2, 3 and 4 of the above, an incomplete LBBB is present. […] A rate-dependent LBBB can occur at times of fast heart rates. […] The Sgarbossa criteria is used in the diagnosis of an acute myocardial infarction when a LBBB is present. […] A score of 3 points is required to diagnose an acute MI. […] Note: Cabreras sign and Chapmans sign have also been used to diagnose acute MI in the setting of a LBBB.

• #13 Left Bundle Branch Block (LBBB) • LITFL • ECG Library Diagnosis

  https://litfl.com/left-bundle-branch-block-lbbb-ecg-library/

  QRS duration 120ms […] In LBBB, conduction delay means that impulses travel first via the right bundle branch to the RV, and then to the LV via the septum […] The delay between activation of the RV and LV produces the characteristic M-shaped R wave seen in lateral leads […] Delayed overall conduction time to the LV extends the QRS duration to 120 ms […] Incomplete LBBB is diagnosed when typical LBBB morphology is associated with a QRS duration 120ms.

• #14 Right Bundle Branch Block – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK507872/

  Right bundle branch block (RBB) is an electrocardiogram finding resulting in a widened QRS and electrocardiographic vector changes. […] This activity reviews the epidemiology, pathophysiology and EKG changes seen in right bundle branch block. […] Summarize the characteristic electrocardiogram findings for right bundle branch block. […] The characteristic ECG findings for right bundle branch block are as follows: QRS duration is greater than or equal to 120 milliseconds. […] In patients without significant heart disease, right bundle branch block does not have any additional risk. […] In patients with cardiovascular disease, right bundle branch block is an independent risk factor for all-cause mortality. […] The presence of a right bundle branch block before acute myocardial infarction, during an acute MI and post-MI, are all associated with higher mortality rates. […] In myocardial infarction, the presence of a left bundle branch block alters the conduction system in such a way that makes the ST segments of the electrocardiogram difficult to interpret. […] In patients wih CHF and RBBB, cardiac resynchronization therapy is indicated.

• #15 Right Bundle Branch Block (RBBB) • LITFL • ECG Library Diagnosis

  https://litfl.com/right-bundle-branch-block-rbbb-ecg-library/

  QRS duration 120ms […] RSR pattern in V1-3 (M-shaped QRS complex) […] Wide, slurred S wave in lateral leads (I, aVL, V5-6) […] In RBBB, the left ventricle is activated normally, thus the early part of the QRS complex correlating to septal depolarisation is unchanged […] There is delayed activation of the right ventricle as depolarisation originates from the left ventricle across the septum. This produces a secondary R wave (R) in the precordial leads, and a wide, slurred S wave in lateral leads […] Normal activation of the left ventricle means that cardiac axis remains normal in isolated RBBB […] Appropriate discordance refers to the fact that abnormal depolarisation should be followed by abnormal repolarisation, which appears discordant to the preceding QRS complex […] In RBBB, this manifests as ST depression and/or T-wave inversion in leads V1-3

• #16 Right bundle branch block (RBBB): ECG, criteria, definitions, causes & treatment – The Cardiovascular

  https://ecgwaves.com/topic/right-bundle-branch-block-rbbb-ecg-criteria-treatment/

  Right bundle branch block (RBBB) is due to an anatomical or functional dysfunction in the right bundle branch, such that the electrical impulse is blocked. […] The hallmark of right bundle branch block is QRS duration 0,12 seconds, large R-wave in V1/V2 and a broad and deep S-wave in V5/V6. […] If QRS duration is between 0,110 seconds and 0,12 seconds, the right bundle branch block is said to be incomplete. […] Right bundle branch block does not affect the electrical axis of the heart. […] The right bundle branch block does not interfere with the diagnosis of ischemia/infarction. It is possible to diagnose pathological Q-waves (because the initial part of the QRS is not affected by the RBBB).

• #17 Incomplete right bundle branch block: Challenges in electrocardiogram diagnosis The Anatolian Journal of Cardiology

  https://anatoljcardiol.com/article/AJC-84375

  Incomplete right bundle branch block (IRBBB), an entity undefined by a general consensus, can express a large pallet of both benign and pathological patterns. […] Usually, IRBBB does not need further evaluation; however, if abnormalities are found on the clinical exam, heart disease should be excluded. […] It is necessary to differentiate IRBBB from pathological patterns such as type-2 Brugada ECG pattern, right ventricular enlargement, arrhythmogenic right ventricular cardiomyopathy, ventricular preexcitationWolf-Parkinson-White syndrome, and hyperkalemia. […] Therefore, clinicians need to be familiar with this ECG finding, which is not always a benign condition.

• #18 Left Bundle Branch Block: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/23287-left-bundle-branch-block

  Left bundle branch block (LBBB) occurs when something blocks or disrupts the electrical impulse that causes your heart to beat. This block leads to an abnormal heart rhythm. A diagnosis of left bundle branch block often means that you have an underlying heart condition. […] Healthcare providers diagnose this condition with an electrocardiogram (EKG). During an EKG, your provider attaches electrodes to the skin of your chest. You lie still while a computer records an image of electrical impulses that travel through your heart. […] If your provider diagnoses you with left bundle branch block, they will check you for other health conditions related to LBBB. They may recommend the following tests: Blood pressure reading to look for high or low blood pressure. Blood test to check cholesterol levels. Echocardiogram to examine blood flow in your heart and check for heart disease. Nuclear cardiac stress test to look for coronary artery disease.

• #19 Right Bundle Branch Block | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/r/right-bundle-branch-block.html

  Right bundle branch block can result from a number of conditions, such as: […] Your healthcare provider can diagnose right bundle branch block with the help of an electrocardiogram (ECG). This test provides information about the heart’s electrical system. People often first find out they have right bundle branch block when having an ECG done for some other reason. A general practitioner or a cardiologist might first diagnose you. […] In addition to the ECG, this evaluation might also include the following tests: […] In healthy people without apparent heart disease, right bundle branch block does not appear to have a significant effect on mortality. You may not need any treatment at all for right bundle branch block. […] Most people with right bundle branch block may not require treatment, but some people may eventually need a pacemaker.

• #20 Electrocardiographic diagnosis of myocardial infarction in the presence of bundle branch block or a paced rhythm – UpToDate

  https://www.uptodate.com/contents/electrocardiographic-diagnosis-of-myocardial-infarction-in-the-presence-of-bundle-branch-block-or-a-paced-rhythm/print

  The ECG diagnosis of acute and prior MI in patients with right bundle branch block (RBBB), left bundle branch block (LBBB), or a right ventricular (RV) paced rhythm will be reviewed here. […] The ECG diagnosis of MI is more difficult when the baseline ECG shows a bundle branch block pattern that may precede or be a complication of the infarct or when the patient has an RV paced rhythm. […] Right bundle branch block was present in approximately 6 percent and left bundle branch block in 7 percent of infarctions. […] Clinicians should be familiar with the effects of right bundle branch block (RBBB) in the settings of acute and prior myocardial infarction. […] RBBB does not usually interfere with the diagnosis of an acute ST-elevation MI (STEMI).

• #21 Bundle branch block – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bundle-branch-block/symptoms-causes/syc-20370514

  Bundle branch block might not need treatment. When it does, treatment involves managing the underlying health condition, such as heart disease, that caused bundle branch block. […] If you have heart disease or have been diagnosed with bundle branch block, ask your provider how often you should have follow-up visits. […] Because bundle branch block affects the electrical activity of the heart, it can sometimes complicate the accurate diagnosis of other heart conditions, especially heart attacks. It may lead to delays in proper management of those heart conditions.

• #22 Electrocardiographic diagnosis of myocardial infarction in the presence of bundle branch block or a paced rhythm – UpToDate

  https://www.uptodate.com/contents/electrocardiographic-diagnosis-of-myocardial-infarction-in-the-presence-of-bundle-branch-block-or-a-paced-rhythm/print

  The ECG diagnosis of acute and prior MI in patients with right bundle branch block (RBBB), left bundle branch block (LBBB), or a right ventricular (RV) paced rhythm will be reviewed here. […] The ECG diagnosis of MI is more difficult when the baseline ECG shows a bundle branch block pattern that may precede or be a complication of the infarct or when the patient has an RV paced rhythm. […] Right bundle branch block was present in approximately 6 percent and left bundle branch block in 7 percent of infarctions. […] Clinicians should be familiar with the effects of right bundle branch block (RBBB) in the settings of acute and prior myocardial infarction. […] RBBB does not usually interfere with the diagnosis of an acute ST-elevation MI (STEMI).

• #23 Diagnosis of Myocardial Infarction in a Patient With Left Bundle Branch Block and Negative Sgarbossa Criteria

  https://www.degruyterbrill.com/document/doi/10.7556/jaoa.2020.107/html?lang=en&srsltid=AfmBOoqD6zb4bAR-PW5KSoKo-OmnI7kADQJNeCfeVDCcshN_n8EooWrn

  Left bundle branch block complicates electrocardiogram interpretation of acute myocardial infarction (MI) because ST segment elevations, commonly used as evidence of MIs, are largely hidden by the repolarization vector. […] To better diagnose acute MI in cases of left bundle branch block, modified Sgarbossa criteria can be used as a clinical tool to help diagnose or exclude MI with high specificity and sensitivity. […] The Sgarbossa criteria were conceived in 1996 and provided a means to more accurately diagnose an acute MI in patients with a LBBB using a 10-point scoring system. […] The modified Sgarbossa criteria include 3 measures, the presence of any 1 of which highly suggests an acute MI: (1) ST elevation of 1 mm or more concordant as the QRS complex in any lead, (2) ST depression of 1 mm or more in any of leads V1-V3, or (3) an ST/S ratio of less than 0.25.

• #24 Left bundle branch block – Wikipedia

  https://en.wikipedia.org/wiki/Left_bundle_branch_block

  LBBB is diagnosed on a 12-lead ECG. In adults, it is seen as wide QRS complexes lasting 120ms with characteristic QRS shapes in the precordial leads, although narrower complexes are seen in children. […] The presence of LBBB results in that electrocardiography (ECG) cannot be used to diagnose left ventricular hypertrophy or Q wave infarction, because LBBB in itself results in a widened QRS complex and changes in the ST segment consistent with ischemia or injury. […] Given the difficulty diagnosing an acute myocardial infarction (AMI) in patients with pre-existing LBBB, a multicenter retrospective cohort study was done to help improve diagnosis of AMI in this patient population. […] The results of the study resulted in the development of the BARCELONA algorithm. Under these criteria, an ECG is positive for an AMI in the presence of LBBB if any of the following criteria are present: […] The BARCELONA algorithm attained the highest sensitivity (95%), significantly higher than Sgarbossa and Modified Sgarbossa rules, as well as the highest negative predictive value (97%), while maintaining 89% specificity.

• #25 Right bundle branch block | Cardiology Today

  https://cardiology.medicinetoday.com.au/ct/2014/march/regular-series/right-bundle-branch-block

  In right bundle branch block, the QRS is over 120 msec, there is an M-shaped QRS complex in the leads V1 to V3 (also known as an RSR pattern) and slurring and widening of the S wave in the lateral limb leads I and aVL and the praecordial leads V5 and V6. […] Right bundle branch block may be considered normal if the cardiac echocardiogram is normal and there are no medical conditions to account for it. […] Right bundle branch block is common in children and is rarely of consequence. […] In people with incomplete right bundle branch block the QRS complex duration by definition will be less than 120 msec. […] Incomplete right bundle branch block is common and usually a normal finding but may be associated with underlying pathology. […] ST segments can still be interpreted with right bundle branch block (but not left bundle branch block) for the diagnosis of myocardial infarction.

• #26 Electrocardiographic diagnosis of myocardial infarction in the presence of bundle branch block or a paced rhythm – UpToDate

  https://www.uptodate.com/contents/electrocardiographic-diagnosis-of-myocardial-infarction-in-the-presence-of-bundle-branch-block-or-a-paced-rhythm/print

  The ECG diagnosis of acute and prior MI in patients with right bundle branch block (RBBB), left bundle branch block (LBBB), or a right ventricular (RV) paced rhythm will be reviewed here. […] The ECG diagnosis of MI is more difficult when the baseline ECG shows a bundle branch block pattern that may precede or be a complication of the infarct or when the patient has an RV paced rhythm. […] Right bundle branch block was present in approximately 6 percent and left bundle branch block in 7 percent of infarctions. […] Clinicians should be familiar with the effects of right bundle branch block (RBBB) in the settings of acute and prior myocardial infarction. […] RBBB does not usually interfere with the diagnosis of an acute ST-elevation MI (STEMI).

• #27 Bundle Branch Block: What to Know

  https://www.webmd.com/heart-disease/bundle-branch-block

  Impulses, or electrical signals, travel through both the left and right chambers of your heart to make it pump. But if the pathway is blocked, the impulses may move slower than normal or irregularly. This is called a bundle branch block. […] If your cardiologist (a heart doctor) spots RBBB through a test called an electrocardiogram (EKG), they may look for underlying heart or lung conditions that could be causing the issue. […] If your cardiologist spots LBBB on an EKG, they may run tests to figure out the cause. Unlike RBBB, left bundle blocks are more often a sign of tissue damage. […] LBBB can make it difficult for your doctor to diagnose other heart conditions. […] Always tell a new doctor if you’ve been diagnosed with LBBB. This will help them do a better job of spotting changes in your heart.

• #28 Bundle branch block – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bundle-branch-block/symptoms-causes/syc-20370514

  Bundle branch block might not need treatment. When it does, treatment involves managing the underlying health condition, such as heart disease, that caused bundle branch block. […] If you have heart disease or have been diagnosed with bundle branch block, ask your provider how often you should have follow-up visits. […] Because bundle branch block affects the electrical activity of the heart, it can sometimes complicate the accurate diagnosis of other heart conditions, especially heart attacks. It may lead to delays in proper management of those heart conditions.

• #29 Right Bundle Branch Block – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK507872/

  Right bundle branch block (RBB) is an electrocardiogram finding resulting in a widened QRS and electrocardiographic vector changes. […] This activity reviews the epidemiology, pathophysiology and EKG changes seen in right bundle branch block. […] Summarize the characteristic electrocardiogram findings for right bundle branch block. […] The characteristic ECG findings for right bundle branch block are as follows: QRS duration is greater than or equal to 120 milliseconds. […] In patients without significant heart disease, right bundle branch block does not have any additional risk. […] In patients with cardiovascular disease, right bundle branch block is an independent risk factor for all-cause mortality. […] The presence of a right bundle branch block before acute myocardial infarction, during an acute MI and post-MI, are all associated with higher mortality rates. […] In myocardial infarction, the presence of a left bundle branch block alters the conduction system in such a way that makes the ST segments of the electrocardiogram difficult to interpret. […] In patients wih CHF and RBBB, cardiac resynchronization therapy is indicated.

• #30 Right Bundle Branch Block | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/r/right-bundle-branch-block.html

  Right bundle branch block can result from a number of conditions, such as: […] Your healthcare provider can diagnose right bundle branch block with the help of an electrocardiogram (ECG). This test provides information about the heart’s electrical system. People often first find out they have right bundle branch block when having an ECG done for some other reason. A general practitioner or a cardiologist might first diagnose you. […] In addition to the ECG, this evaluation might also include the following tests: […] In healthy people without apparent heart disease, right bundle branch block does not appear to have a significant effect on mortality. You may not need any treatment at all for right bundle branch block. […] Most people with right bundle branch block may not require treatment, but some people may eventually need a pacemaker.

• #31 Right Bundle Branch Block – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK507872/

  Right bundle branch block (RBB) is an electrocardiogram finding resulting in a widened QRS and electrocardiographic vector changes. […] This activity reviews the epidemiology, pathophysiology and EKG changes seen in right bundle branch block. […] Summarize the characteristic electrocardiogram findings for right bundle branch block. […] The characteristic ECG findings for right bundle branch block are as follows: QRS duration is greater than or equal to 120 milliseconds. […] In patients without significant heart disease, right bundle branch block does not have any additional risk. […] In patients with cardiovascular disease, right bundle branch block is an independent risk factor for all-cause mortality. […] The presence of a right bundle branch block before acute myocardial infarction, during an acute MI and post-MI, are all associated with higher mortality rates. […] In myocardial infarction, the presence of a left bundle branch block alters the conduction system in such a way that makes the ST segments of the electrocardiogram difficult to interpret. […] In patients wih CHF and RBBB, cardiac resynchronization therapy is indicated.

• #32 Bundle Branch Block – Heart and Blood Vessel Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/heart-and-blood-vessel-disorders/abnormal-heart-rhythms/bundle-branch-block

  Bundle branch block can be detected by electrocardiography (ECG). Each type of block produces a characteristic pattern. […] Bundle branch block usually causes no symptoms. Right bundle branch block is not serious in itself and may occur in apparently healthy people. However, it may also indicate significant heart damage due to, for example, a previous heart attack. […] Left bundle branch block tends to be more serious. In older adults, it often indicates coronary artery disease due to atherosclerosis. […] Bundle branch block itself usually requires no treatment unless all the bundle branches are blocked. However, if the block was caused by an underlying heart disorder, that disorder may require treatment.

• #33 Left Bundle Branch Block: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/23287-left-bundle-branch-block

  Left bundle branch block (LBBB) occurs when something blocks or disrupts the electrical impulse that causes your heart to beat. This block leads to an abnormal heart rhythm. A diagnosis of left bundle branch block often means that you have an underlying heart condition. […] Healthcare providers diagnose this condition with an electrocardiogram (EKG). During an EKG, your provider attaches electrodes to the skin of your chest. You lie still while a computer records an image of electrical impulses that travel through your heart. […] If your provider diagnoses you with left bundle branch block, they will check you for other health conditions related to LBBB. They may recommend the following tests: Blood pressure reading to look for high or low blood pressure. Blood test to check cholesterol levels. Echocardiogram to examine blood flow in your heart and check for heart disease. Nuclear cardiac stress test to look for coronary artery disease.

• #34 Left Bundle Branch Block: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/23287-left-bundle-branch-block

  If you have symptoms such as fainting, your provider may recommend a pacemaker. Pacemakers are typically indicated when you have a conduction abnormality along with a LBBB. A surgeon implants this device under your skin in your chest. Wires connected to your heart help manage your hearts signals so that it beats at a steady rate. […] If you see a new doctor, always tell them if you have left bundle branch block. This information will help them better monitor your heart health and overall wellness.

• #35 Right Bundle Branch Block | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/r/right-bundle-branch-block.html

  Right bundle branch block can result from a number of conditions, such as: […] Your healthcare provider can diagnose right bundle branch block with the help of an electrocardiogram (ECG). This test provides information about the heart’s electrical system. People often first find out they have right bundle branch block when having an ECG done for some other reason. A general practitioner or a cardiologist might first diagnose you. […] In addition to the ECG, this evaluation might also include the following tests: […] In healthy people without apparent heart disease, right bundle branch block does not appear to have a significant effect on mortality. You may not need any treatment at all for right bundle branch block. […] Most people with right bundle branch block may not require treatment, but some people may eventually need a pacemaker.

• #36 Diagnosis of right bundle branch block: a concordance study | BMC Primary Care | Full Text

  https://bmcprimcare.biomedcentral.com/articles/10.1186/s12875-019-0946-3

  Right bundle branch block is one of the most common electrocardiographic abnormalities. Most cases of right bundle branch block are detected in asymptomatic patients in primary care, so a correct interpretation of electrocardiograms (ECGs) at this level is necessary. […] The objective of this research is to determine the degree of concordance in the diagnosis of incomplete and complete right bundle branch block between four primary care researchers and a cardiologist. […] The diagnosis of incomplete and complete right bundle branch block was recorded and other secondary variables were analysed. […] The interobserver agreement in the diagnosis of right bundle branch block performed by physicians specialized in ECG interpretation (primary care physicians and a cardiologist) was very good. The variability was greater for the diagnosis of incomplete right bundle branch block.

• #37 Diagnosis of right bundle branch block: a concordance study | BMC Primary Care | Full Text

  https://bmcprimcare.biomedcentral.com/articles/10.1186/s12875-019-0946-3

  There is no unanimous consensus on the diagnostic criteria of RBBB in the literature. […] The implications of detecting BBB, especially in prognosis, mean that ECG readings must be performed carefully for the conclusions to be valid. […] Our study shows that interobserver agreement in the diagnosis of RBBB performed by physicians specialized in ECG interpretation (both PC physicians and cardiologists) is very good. The variability is greater for the diagnosis of iRBBB, since there is greater diversity in the diagnostic criteria regarding the duration of the QRS complex. Unifying the criteria would help achieve a better diagnosis so that additional examinations can be made when necessary.

• #38

  https://link.springer.com/article/10.1007/s12471-022-01697-5

  Correctly diagnosing left bundle branch block (LBBB) is fundamental, as LBBB occurs frequently in heart failure and may trigger a vicious cycle of progressive left ventricular dysfunction. […] Moreover, a correct diagnosis of LBBB is pivotal to guide cardiac resynchronisation therapy. […] However, correct electrocardiographic assessment of LBBB is fundamental, as true LBBB is associated with the presence of LBBB-induced dyssynchrony and improves selection of patients eligible for CRT. […] More recent studies consistently showed that the European Society of Cardiology (ESC) 2013 and the Strauss definitions had the highest sensitivity for predicting both echocardiographic and clinical response to CRT, whereas the American Heart Association (AHA) definition had the highest specificity, suggesting that the highly selective AHA definition may be too stringent.

• #39

  https://link.springer.com/article/10.1007/s12471-022-01697-5

  Recently, the ESC proposed new electrocardiographic criteria to define LBBB. […] The updated ESC 2021 definition emphasises on the importance of QRS notching/slurring and delayed R-wave peak time, and provides new recommendations on ST-segment and T-wave assessment. […] The ESC 2013 definition identifies significantly more LBBB patients than the ESC 2021 definition. […] Previous studies favour the incorporation of QRS notching/slurring, which was consistently shown to be a hallmark for electrocardiographic LBBB. […] However, the use of too selective criteria for diagnosing LBBB might cause underdiagnosis of LBBB, as shown by our analysis. […] From a pathophysiological and clinical point of view, broad LBBB inclusion criteria, including lateral QRS notching/slurring, seem reasonable to achieve high sensitivity.

• #40 Automatic diagnosis of strict left bundle branch block using a wavelet-based approach | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0212971

  Patients with left bundle branch block (LBBB) are known to have a good clinical response to cardiac resynchronization therapy. However, the high number of false positive diagnosis obtained with the conventional LBBB criteria limits the effectiveness of this therapy, which has yielded to the definition of new stricter criteria. […] The aim of this work was to develop and assess a fully-automatic algorithm for strict LBBB diagnosis based on the wavelet transform. […] In the validation set, LBBB was diagnosed with a sensitivity and specificity of Se = 92.9% and Sp = 65.1% (Acc = 79.5%, PPV = 74% and NPV = 89.6%). […] The results confirmed that diagnosis of strict LBBB can be done based on a fully automatic extraction of temporal and morphological QRS features. […] However, it became evident that consensus in the definition of QRS duration as well as notch and slurs definitions is necessary in order to guarantee accurate and repeatable diagnosis of complete LBBB.

• #41 Automatic diagnosis of strict left bundle branch block using a wavelet-based approach | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0212971

  According to the strict LBBB criteria, diagnosis of LBBB requires delineation of QRS boundaries, identification of QRS morphological pattern as well as the presence of notches and/or slurs within the QRS complex in selected leads. […] The strict LBBB criteria proposed by Strauss et al. arise as a consequence of the reduced effectiveness of CRT therapy in patients diagnosed with conventional LBBB but actually did no present a complete blockage on the left bundle. […] In conclusion, the presented methodology allows diagnosis of strict LBBB based on a fully automatic extraction of temporal and morphological QRS features. However, consensus in the definition of QRS duration as well as notch and slur definitions becomes necessary in order to guarantee a proper and repeatable diagnosis of strict LBBB based on precise and reliable measurements.

• #42

  https://link.springer.com/article/10.1007/s12471-022-01697-5

  Recently, the ESC proposed new electrocardiographic criteria to define LBBB. […] The updated ESC 2021 definition emphasises on the importance of QRS notching/slurring and delayed R-wave peak time, and provides new recommendations on ST-segment and T-wave assessment. […] The ESC 2013 definition identifies significantly more LBBB patients than the ESC 2021 definition. […] Previous studies favour the incorporation of QRS notching/slurring, which was consistently shown to be a hallmark for electrocardiographic LBBB. […] However, the use of too selective criteria for diagnosing LBBB might cause underdiagnosis of LBBB, as shown by our analysis. […] From a pathophysiological and clinical point of view, broad LBBB inclusion criteria, including lateral QRS notching/slurring, seem reasonable to achieve high sensitivity.

• #43

  https://link.springer.com/article/10.1007/s12471-022-01697-5

  In addition, ancillary electro- and echocardiographic criteria, such as a delayed R-wave peak time, a leftward oriented QRS axis and the presence of septal flash, apical rocking or specific septal strain patterns may be considered to improve the specificity and achieve maximal accuracy for diagnosing LBBB.

• #44 Bundle Branch Block: Types, Symptoms, Treatment and More

  https://www.verywellhealth.com/bundle-branch-block-bbb-1745219

  Identifying a bundle branch block relies on diagnostic testing that includes a 12-lead ECG and an echocardiogram. An ECG is a non-invasive test that uses electrodes placed on the surface of the chest to detect heart rhythm. An echocardiogram is a non-invasive ultrasound that visualizes the heart as it beats, potentially detecting disruptions in rhythm. […] In many cases, one test alone will show the pattern consistent with bundle branch block, both tests won’t be necessary. […] A bundle branch block might be detected with an echocardiogram. This non-invasive test allows healthcare providers to visualize the motion and rhythm of the heart as it beats. […] If you have a bundle branch block, your healthcare provider might order an echocardiogram for you so your medical team will be better able to assess the impact of your conduction disorder.

• #45 Left Bundle Branch Block – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482167/

  According to the American College of Cardiology, American Heart Association, and Heart Rhythm Society, complete LBBB is defined by the following ECG features: QRS duration greater than or equal to 120 ms. […] The European Society of Cardiology provided the following criteria for diagnosis of LBBB in 2021: QRS duration greater than or equal to 120 ms. […] A TTE is warranted for further evaluation of underlying structural heart disease in these individuals. […] The ECG tracing should be evaluated thoroughly to confirm the presence of LBBB based on known criteria. […] The presence of LBBB post-TAVR can increase the risk of developing high-grade atrioventricular block, requiring permanent pacemaker implantation. […] Patients with isolated, asymptomatic LBBB without other conduction disturbances may not require immediate pacemaker implantation.

• #46 Bundle branch block – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bundle-branch-block/diagnosis-treatment/drc-20370518

  If you have a right bundle branch block and you’re otherwise healthy, you might not need a full medical checkup. If you have a left bundle branch block, you will need a thorough medical exam. […] Tests that can be used to diagnose a bundle branch block or its causes include: […] Electrocardiogram (ECG or EKG). This quick and painless test measures the electrical activity of the heart. During an electrocardiogram (ECG), sensors (electrodes) are attached to the chest and sometimes to the arms or legs. An can show how well the heart is beating. It can show signs of a bundle branch block, as well as which side of the heart is being affected. […] Echocardiogram. This test uses sound waves to provide detailed images of the heart and heart valves. It can show the structure and the thickness of the heart muscle. Your provider can use this test to pinpoint a condition that caused the bundle branch block.

• #47 Right Bundle Branch Block | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/r/right-bundle-branch-block.html

  Right bundle branch block can result from a number of conditions, such as: […] Your healthcare provider can diagnose right bundle branch block with the help of an electrocardiogram (ECG). This test provides information about the heart’s electrical system. People often first find out they have right bundle branch block when having an ECG done for some other reason. A general practitioner or a cardiologist might first diagnose you. […] In addition to the ECG, this evaluation might also include the following tests: […] In healthy people without apparent heart disease, right bundle branch block does not appear to have a significant effect on mortality. You may not need any treatment at all for right bundle branch block. […] Most people with right bundle branch block may not require treatment, but some people may eventually need a pacemaker.

• #48 Right Bundle Branch Block | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/r/right-bundle-branch-block.html

  Right bundle branch block can result from a number of conditions, such as: […] Your healthcare provider can diagnose right bundle branch block with the help of an electrocardiogram (ECG). This test provides information about the heart’s electrical system. People often first find out they have right bundle branch block when having an ECG done for some other reason. A general practitioner or a cardiologist might first diagnose you. […] In addition to the ECG, this evaluation might also include the following tests: […] In healthy people without apparent heart disease, right bundle branch block does not appear to have a significant effect on mortality. You may not need any treatment at all for right bundle branch block. […] Most people with right bundle branch block may not require treatment, but some people may eventually need a pacemaker.

• #49 Left Bundle Branch Block – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482167/

  According to the American College of Cardiology, American Heart Association, and Heart Rhythm Society, complete LBBB is defined by the following ECG features: QRS duration greater than or equal to 120 ms. […] The European Society of Cardiology provided the following criteria for diagnosis of LBBB in 2021: QRS duration greater than or equal to 120 ms. […] A TTE is warranted for further evaluation of underlying structural heart disease in these individuals. […] The ECG tracing should be evaluated thoroughly to confirm the presence of LBBB based on known criteria. […] The presence of LBBB post-TAVR can increase the risk of developing high-grade atrioventricular block, requiring permanent pacemaker implantation. […] Patients with isolated, asymptomatic LBBB without other conduction disturbances may not require immediate pacemaker implantation.

• #50 Bundle Branch Block: What to Know

  https://www.webmd.com/heart-disease/bundle-branch-block

  Impulses, or electrical signals, travel through both the left and right chambers of your heart to make it pump. But if the pathway is blocked, the impulses may move slower than normal or irregularly. This is called a bundle branch block. […] If your cardiologist (a heart doctor) spots RBBB through a test called an electrocardiogram (EKG), they may look for underlying heart or lung conditions that could be causing the issue. […] If your cardiologist spots LBBB on an EKG, they may run tests to figure out the cause. Unlike RBBB, left bundle blocks are more often a sign of tissue damage. […] LBBB can make it difficult for your doctor to diagnose other heart conditions. […] Always tell a new doctor if you’ve been diagnosed with LBBB. This will help them do a better job of spotting changes in your heart.

• #51 Left Bundle Branch Block: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/23287-left-bundle-branch-block

  If you have symptoms such as fainting, your provider may recommend a pacemaker. Pacemakers are typically indicated when you have a conduction abnormality along with a LBBB. A surgeon implants this device under your skin in your chest. Wires connected to your heart help manage your hearts signals so that it beats at a steady rate. […] If you see a new doctor, always tell them if you have left bundle branch block. This information will help them better monitor your heart health and overall wellness.

• #52 Bundle branch block – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bundle-branch-block/symptoms-causes/syc-20370514

  Bundle branch block might not need treatment. When it does, treatment involves managing the underlying health condition, such as heart disease, that caused bundle branch block. […] If you have heart disease or have been diagnosed with bundle branch block, ask your provider how often you should have follow-up visits. […] Because bundle branch block affects the electrical activity of the heart, it can sometimes complicate the accurate diagnosis of other heart conditions, especially heart attacks. It may lead to delays in proper management of those heart conditions.

• #53 What Is Bundle Branch Block?

  https://www.icliniq.com/articles/heart-circulatory-health/bundle-branch-block

  How Is a Bundle Branch Block Diagnosed? […] Different tests that can diagnose a bundle branch block are- […] Electrocardiogram (ECG or EKG)- It is a quick and painless test that measures the electrical activity in the heart. During the procedure, the technician will attach sensors (or electrodes) to the chest that will record the electrical signals in the heart. It can identify the signs and location of the block. […] Echocardiogram- Similar to an ultrasound, an echocardiogram uses sound waves to provide detailed images of the heart and its valves. It will identify the thickness and extent of the structure of the bundle branches. […] Diagnosing a branch bundle block is crucial in preventing future life-threatening heart conditions. If the clinician suspects a block, either symptomatic or asymptomatic, they should refer the patient to a cardiologist for further review. Treatment will improve the quality of life and lifespan of the patient because the focus is on the underlying condition rather than the block itself.

Zobacz więcej