Video review: Left versus right bundle branch (LBBB; RBBB) block tips for students and new nurses
Here are three tricks I wish I’d known when first learning bundle branch block identification as a new nurse!
1) First up is the paper flip method:
We’re going to take our ECG and rotate it one quarter turn to the right, 90 degrees. Now, which way is the wide QRS in lead V1 pointing? If it points left, this would suggest presence of a left bundle branch block (LBBB). If the majority of the QRS is pointing to the right, or is biphasic (partially below and above the isoelectric baseline), this would suggest presence of a right bundle branch block (RBBB). Of course, we want to use Leads I and V6 to confirm for both patterns.
2) Next up is my personal favorite: The bundle branch block turn signal:
Using V1, imagine you’re driving in your car and you want to signal a right-hand turn. Did you flip the turn signal up… or down? That’s right, up (hopefully)! But if we were to signal a left-hand turn, we’d flip it down.
3) Finally, we have the memory devices WiLLiaM and MaRRoW:
This involves superimposing the letters “W” and “M” over V1 and V6 for a LBBB; and then using the letters “M” and “W” respectively for a RBBB as illustrated above.
So there we have it! All of these take a little time and practice, but those are the three memory tricks I wish I’d known when first learning to recognize bundle branch block identification! Hope this helps!
*From a basic and introductory nursing perspective. Exceptions may exist. Non-conclusive list of possible waveform appearances.
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