Intraventricular Conduction: Difference between revisions

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== LBBB vs RBBB ==
== LBBB vs RBBB ==
[[Image:Verschil_LBTB-RBTB.png|thumb| A bundle branch block causes a delay in the depolarization of the right (RBBB) or left (LBBB) ventricle. In RBBB the QRS complex shows a second peak or R' in V1.]]
Check V1 for QRS > 0,12 sec.
Check V1 for QRS > 0,12 sec.
When the last QRS in V1 is below the baseline (moving away from V1), a LBBB is the most likely diagnosis.  
When the last QRS in V1 is below the baseline (moving away from V1), a LBBB is the most likely diagnosis.  
When the last activity is above the baseline, it's a RBBB
When the last activity is above the baseline, it's a RBBB.
[[Image:Verschil_LBTB-RBTB.png|thumb| A bundle branch block causes a delay in the depolarization of the right (RBBB) or left (LBBB) ventricle. In RBBB the QRS complex shows a second peak or R' in V1.]]
If the QRS > 0.12 sec. but the morphological criteria of LBBB or RBBB do not apply, it is called 'interventriculair conduction delay', a general term.  
If the QRS > 0.12 sec. but the morphological criteria of LBBB or RBBB do not apply, it is called 'interventriculair conduction delay', a general term.  
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[[Image:12leadLBTB.png|thumb| Left bundle branch Block on a 12 lead ECG.]]
[[Image:12leadLBTB.png|thumb| Left bundle branch Block on a 12 lead ECG.]]


Bij een '''linker bundeltakblok''' (LBTB), is de geleiding door de linker bundel vertraagd. Het begin van de depolarisatie is normaal, maar de laterale wand van de linker ventrikel depolariseert dus sterk vertraagd. Hierdoor is er nog electrische activiteit in de linker ventrikel op het moment dat de rest van het hart al 'klaar' is, deze wordt dus niet meer geneutraliseerd door de rechter ventrikel. De laatste activiteit gaat dus naar links, ofwel van V1 af. Met deze kennis is een LBTB makkelijk te begrijpen. Het resultaat ziet er als volgt uit:
In ''left bundle branch block'' (LBBB) the conduction in the left bundle is slow. This results in delayed depolarisation of the left ventricle, especially the left lateral wall. The electrical activity in the left lateral wall is unopposed by the usual right ventricular electrical activity. The last activity on the ECG thus goes to the left or away from V1. Once you remember this, LBBB is easy to understand.
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