In right bundle branch block, what pattern is typically seen in V1–V2?

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Multiple Choice

In right bundle branch block, what pattern is typically seen in V1–V2?

In right bundle branch block the impulse reaches the left ventricle first and the right ventricle is activated later. That delay changes the depolarization pattern seen in the right precordial leads, V1 and V2. The classic finding is an rsR' pattern there—an initial small R, followed by an S wave, and then a second positive deflection (R') with a notch. This gives the characteristic “bunny ears” appearance in V1–V2 and reflects late activation of the right ventricle. A qR pattern would have a prominent initial Q wave with a larger R, which isn’t the typical appearance in V1–V2 for RBBB. A tall R wave in V6 points more toward left-sided patterns like LBBB or LVH. Absence of an R wave in V1 would yield a QS pattern, not the rsR' pattern seen with RBBB.

In right bundle branch block the impulse reaches the left ventricle first and the right ventricle is activated later. That delay changes the depolarization pattern seen in the right precordial leads, V1 and V2. The classic finding is an rsR' pattern there—an initial small R, followed by an S wave, and then a second positive deflection (R') with a notch. This gives the characteristic “bunny ears” appearance in V1–V2 and reflects late activation of the right ventricle.

A qR pattern would have a prominent initial Q wave with a larger R, which isn’t the typical appearance in V1–V2 for RBBB. A tall R wave in V6 points more toward left-sided patterns like LBBB or LVH. Absence of an R wave in V1 would yield a QS pattern, not the rsR' pattern seen with RBBB.

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