Bifascicular Block

The term bifascicular block refers to conduction blocks over two fascicles: (1) RBB and LASF, (2) RBB and LPIF, or (3) left bundle branch (LBB) block.

In LBB block, ventricular activation is by way of the RBB and proceeds from right to left and inferior to superior. The ECG characteristics of LBB block are (1) prolonged QRS duration (greater than 0.12 s); (2) large and wide R waves in leads I, aV L, V5, and V6; (3) small r wave followed by deep S wave in leads II, iIi, aVF, and V! to V3; and (4) no q waves in leads I, aVF, V5, and V6 (Fig.:..., .2.4:34.).

FIG. 24-34. Left bundle branch block (LBB block).

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