IRBBB is a partial delay in electrical conduction through the right bundle branch, causing a mild widening of the QRS complex on an ECG.

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Here’s a detailed overview of Incomplete Right Bundle Branch Block (IRBBB) based on current clinical literature and guidelines:

🧠 What Is Incomplete RBBB?

  • It is distinguished from complete RBBB mainly by the QRS duration, which falls between 100–120 ms (typically 100–119 ms in adults) (ecglectures.com, Wikipedia).

  • ECG criteria include:

    • rsR′, rSR′, or rsr′ pattern in leads V1 or V2

    • A broad S wave in leads I and V6

    • QRS <120 ms, yet wider than normal (ecglectures.com, Coding Ahead LLC)

👥 Who Gets It—and What It Means

  • IRBBB is common in healthy individuals, especially in young adults, athletes, and males, often as a benign variant with no underlying disease (PubMed).

  • It can be seen in conditions such as:

    • Right ventricular strain (e.g., pulmonary hypertension, pulmonary embolism)

    • Congenital heart defects (e.g., atrial septal defect)

    • Structural diseases (e.g., cardiomyopathy, ischemic heart disease) (PMC, Reddit, Wikipedia).

  • Sometimes electrode misplacement—especially placement of V1/V2 higher than the fourth intercostal space—can mimic IRBBB patterns on ECG (Reddit).

✅ Clinical Significance & What to Do

As an isolated finding (no symptoms, no other ECG abnormalities, no risk limits):

  • Typically benign, requiring no treatment or follow-up (Reddit).

  • Common experience:

    “IRBBB is a common and normal variant of no clinical significance… absolutely nothing to worry about especially if it is an isolated finding.” (Reddit)

If accompanied by symptoms, exam abnormalities, or risk factors:

  • Additional evaluation may be warranted, including:

    • Echocardiogram

    • Chest imaging

    • Evaluation for abnormalities like right‐sided heart pressure, congenital defects, or cardiomyopathy (Verywell Health, PubMed).

Long‑term implications:

  • A longitudinal study found that while IRBBB did not increase cardiovascular or coronary mortality, it modestly increased the risk of progressing to complete RBBB over time in middle‑aged men (PubMed).

📊 Summary Table

Feature Incomplete RBBB (IRBBB)
QRS duration ~100–119 ms (vs ≥120 ms in complete RBBB)
ECG pattern rsR′ or rSR′ in V1/V2; slurred S wave in I and V6
Common in Young healthy adults, athletes, males
Usually significance Benign if isolated
When to investigate further With symptoms, risk factors, or other ECG/clinical findings
Risk of progression Slightly elevated toward complete RBBB
Mortality risk Not elevated if isolated

🩺 What Should You Do?

  • 🟢 No further action needed if IRBBB is isolated and you're asymptomatic.

  • 🔍 See a cardiologist if accompanied by:

    • Relevant symptoms (e.g. palpitations, dizziness)

    • Other ECG abnormalities

    • Risk factors such as congenital heart disease, pulmonary issues, hypertension

  • 🧩 If misplacement of ECG leads is suspected, a repeat ECG with correct lead placement can help confirm whether the pattern persists (ecglectures.com, Reddit, Verywell Health, Europe PMC).

TL;DR

Incomplete RBBB is usually a harmless, common ECG finding, especially in young, healthy, or athletic individuals. It rarely reflects heart disease and typically does not require intervention, unless other symptoms or findings are present. If you're concerned or symptomatic, a consultation with your healthcare provider is reasonable.

Feel free to share more context—such as your age, symptoms, or whether other findings were present—and I’ll help interpret further!


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