LBBB

Criteria for left bundle branch block (LBBB) [1]

QRS >0,12 sec

Broad monomorphic R waves in I and V6 with no Q waves

Broad monomorphic S waves in V1, may have a small r wave

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.

In a LBBB, the left ventricle is depolarized later than the right ventricle.

In a LBBB, the last depolarization wave is in the left ventricle. This wave is directed away from V1. On the ECG, V1 will show a negative complex.

Left bundle branch Block on a 12 lead ECG.

Diagnosis of myocardial infarction in LBBB is difficult as the ST segment is allways abnormal.