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Patient
Asymptomatic 24-year-old man;
Trace
Sinus rhythm, typical complete right bundle branch block pattern: QRS duration 130 ms; V1: rSR' pattern, delayed intrinsicoid deflection, negative T wave; V6: qRS pattern with septal q wave and wide slurred S wave;
Exergue
Right bundle branch block is characterized by a disruption of the vectors of the second part of the QRS; the activation of the left ventricle is normal explaining the normality of the vectors of the first part of the QRS; late activation of the right ventricle adds abnormal vectors directed to the right at the end of the QRS which considerably deform the terminal portion of the QRS.
This patient presents a complete right bundle branch block in an otherwise healthy heart. Since electrical conduction is interrupted in the right branch, activation of the left ventricle is normal, while that of the right ventricle is delayed.