Bundle of His divides into right and left branches. The left branch divides into three divisions:
All these branches may be involved singly or in combinations.
N.B. It is a normal finding in all ages.
Bundle branch block is essentially diagnosed from ECG but clinically in RBBB wide splitting of S, is seen with evidence of right ventricular enlargement. Similarly in LBBB reversed splitting of the second heart sound with evidence of left ventricular enlargement may be found.
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This is based on ECG finding.RBBB: Right axis, wide QRS duration (0.12 second or more in complete RBBB; in incomplete RBBB 0.10 to just below 0.12 second), wide S in lead I, intrinsicoid, deflection over V1 is more than 0.02 sec and there is rSR or M pattern. When left anterior fascicular block is present in addition, there will be left axis, deep S in Leads II, III, q in I and aVL and r in III, and R in aVL.
LBBB: Left axis, wide QRS (0.12 second or more in complete LBBB; 0.10 to just below 0.12 second in incomplete LBBB), wide, notched and slurred R in Leads I, aVL, V Intruisicoid dylection in V5-6 is more than 0.05 sec. BUNDLE BRANCH BLOCK
Left anterior fascicular block: Narrow QRS duration, small g in Leads I, aVL and small r in Lead III, mean frontal plane QRS axis is -30°. This is also called left anterior hemiblock .
Left posterior fascicular block: Narrow QRS duration mean frontal plane axis +900. Small q in III and small r in I and aVL. This is also called left posterior hemiblock.
Septal fascicular block: Absence of Q wave in V5-6. Bifasicular block: It is consists of RBBB with any of Left anterior and posterior fasicular block.
Trifasicular block: it consist of RBBB, with left anterior fasicular block and left posterior fasicular block.
TREATMENT
This is done acceding to the underlying cause. When syncope is present pace-maker should be implanted.
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