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By M. Gabriel Khan.

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Genesis of the QRS complex in right bundle branch block. (From Khan, M. ) 40 Rapid ECG Interpretation A Fig. 2-7. 12 second; RSR′ (M-shaped complex) in V1; and wide, slurred S wave in leads 1, V5, and V6 indicate right bundle branch block. Chapter 2 / Step-by-Step Method for Accurate ECG Interpretation 41 B Fig. 2-7. B, Limb leads; slurred, wide S wave in lead I, and the amplitude (length or duration) of the S wave is greater than the preceeding R wave. 42 Rapid ECG Interpretation AV node Left bundle branch block R L V(I) V(II) Electrode V1 V(III) Electrode V6 V(III) V(III) V(II) V(I) V(I) V(I) A V(II) V(II) V(III) Fig.

2-8. A, The contribution of vectors I, II, and III, labeled V(I), V(II), and V(III), to the genesis of left bundle branch block. (From Khan, M. ). 12 second; small R waves in V1 to V3; and notched R wave in V5 indicate left bundle branch block. STEP 3: ASSESS FOR NONSPECIFIC INTRAVENTRICULAR CONDUCTION DELAY AND WOLFF-PARKINSON-WHITE SYNDROME (FIG. 11 second and bundle branch block appears to be present but is atypical, consider WPW syndrome, particularly if there is a tall R wave in V1 and V2 (Table 2-3; see also Figs.

The small notch on the R wave of leads II, III, and aVF is a normal finding in some individuals and does not indicate intraventricular conduction delay (see Chapter 4). 22 second in adults). 12 second) in duration, and amplitude <3 mm. Upright in lead I, inverted in aVR (if opposite, suspect reversed arm leads† or dextrocardia) (see Step 6, Figs. 2-21 and 2-36). 1 second, consider incomplete LBBB, incomplete RBBB, or WPW syndrome (see Steps 2 and 3, Figs. 2-4, 2-9, and 2-10). Q waves Normally present in aVR; occasionally in V1 or in aVL (vertical heart) (see Chapter 6).

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