Figure - available from: International Medical Case Reports Journal
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12 lead ECG showing MBBB precordial type. RBBB in right precordial leads, absent deep S waves in lead V5, V6 and I. LBBB in left precordial leads.
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Background:
Masquerading bundle branch block (MBBB) is a rare and important electrocardiographic pattern. It consists of right bundle branch block (RBBB) in precordial leads and left bundle branch block (LBBB) in limb leads. It indicates advanced conduction system abnormality usually associated with severe underlying heart disease. MBBB is associa...
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Citations
... There are concerns of heart block onset in patients with atypical RBBB. 23 These patients usually have severe underlying heart disease and may develop HF. 24 HF in our patient worsened after the QRS morphology changed to atypical RBBB and it became progressively more difficult to manage HF pharmaceutically ( Figure 2). We believe that patients with atypical RBBB and symptoms of HF should be considered for early treatment, such as CRT, to ensure optimal timing of device implantation. ...
A subgroup of right bundle branch block (RBBB) patients may exhibit a significant left ventricular (LV) activation delay. We evaluated echocardiography in a non-ischemic heart failure patient whose QRS morphology changed from left bundle branch block (LBBB) to atypical RBBB. The septum to posterior wall motion delay (SPWMD) measured using the M-mode was 196 ms while the patient presented with LBBB but decreased to 32 ms after the morphology changed to RBBB. These changes were also associated with delayed appearance of the septal displacement peak. Speckle tracking longitudinal strain was evaluated using three standard apical views after the morphology changed to RBBB. The LV contraction initially appeared in the basal inferior wall and there was delayed anterior wall contraction. The LV contraction pattern in our patient changed when the QRS morphology changed to atypical RBBB. A specific LV contraction sequence observed in atypical RBBB may reflect a significant LV activation delay between the inferior and anterior wall.
