RBBB as Monophasic R wave in V1
Report:
Sinus rhythm 94/min
Left anterior hemiblock
QRS axis â40o
Right bundle branch block
Comment:
RBBB can be manifest as pure R wave in V1, especially in the presence of a hemiblock. One could not, without a baseline trace in sinus rhythm, diagnose SVT in this patient. It would look like VT.
Oddly enough, to disprove the above, the patient did develop SVT while still in ICU (below) but its QRS pattern was typical rsRâ of RBBB and there was clear-cut evidence of associated regular atrial activity. The hemiblock remained unchanged.
The tracings are a good illustration of lead V1 superiority over lead 2.
Fig 29a. Unexpected improvement in RBBB conduction during SVT. Sometimes conductivity improves at higher speed, or else the bundle branches come to be better synchronised. I did not pretend to know the answer. The ICU staff are not very forgiving.
Fig 30. 36 year old lady arresting at home at 26 weeksâ pregnancy; echocardiography showed dilated cardiomyopathy.
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