Bifascicular Block Beat - (BBBI)
Definition
Section titled “Definition”A block involving two fascicles—for example, RBBB plus left anterior fascicular block, or RBBB plus left posterior fascicular block.
Criteria
Section titled “Criteria”-
QRS duration: >120 ms.
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Indications of right bundle branch block plus either left anterior or left posterior fascicular block (e.g., axis deviation).
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For RBBB + LAFB (left anterior fascicular block), expect a left axis deviation and typical RBBB pattern in V1–V2.
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For RBBB + LPFB (left posterior fascicular block), expect a right axis deviation with RBBB features.
Additional Points (Examples)
Section titled “Additional Points (Examples)”-
In RBBB + LAFB, in V1–V2 you often see rsR’, rSR’, or rSr’ with a wide R’.
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In V5–V6, lead I, and aVL, qRS with a wide S is frequently present.
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In RBBB + LPFB, the axis is markedly to the right, V1–V2 can have rsR’, rSR’, etc., with a tall R’, while V5–V6 can have a wide S wave.
Priority
Section titled “Priority”The priority of the annotation is determined by the severity of the event.
| Priority | Highest | High | Medium | Low | Lowest |
|---|---|---|---|---|---|
| Continuous | - | - | 1 | - | - |
| Per Minute | - | - | - | - | - |
| Per Hour | - | - | - | - | - |
| Per 24 Hours | - | - | 1000 | - | - |
Compatibility
Section titled “Compatibility”These annotations indicate whether they can overlap with other annotations, clarifying their exclusivity or compatibility.
| Label | Description | Compatibility |
|---|---|---|
| UNK | Unclassifiable Beat | ❌ |
| AESC | Atrial Escape Beat | ✅ |
| NPW | Non-Conducted P-Wave (Blocked) | ✅ |
| APC | Atrial Premature Contraction | ✅ |
| ABER | Aberrated Beat | ❌ |
| BBLA | Left Anterior Fascicular Block Beat (Common) | ❌ |
| BBBI | Bifascicular Block Beat | ❌ |
| BBBL | Bilateral Bundle-Branch Block Beat | ❌ |
| BBU | Intraventricular Conduction Disturbance (Non-Specific Block) | ❌ |
| BBLP | Left Posterior Fascicular Block Beat (Rare) | ❌ |
| JESC | Junctional (Nodal) Escape Beat | ✅ |
| JPC | Junctional (Nodal) Premature Contraction | ✅ |
| LBB | Left Bundle Branch Block Beat | ❌ |
| N | Normal Beat | ❌ |
| RBB | Right Bundle Branch Block Beat | ❌ |
| RBBI | Incomplete Right Bundle Branch Block Beat | ❌ |
| VESC | Ventricular Escape Beat | ❌ |
| VPC | Ventricular Premature Contraction | ❌ |
| VPCF | Fusion Of Ventricular And Normal Beat | ❌ |
| RONT | R-On-T Premature Ventricular Beat | ❌ |
| Z | Noise Moderate | ✅ |
| ZZ | Noise Severe | ❌ |
| PAUS | Pause | ✅ |
| ABI | Atrial Bigeminy | ✅ |
| AERY | Atrial Ectopic Rhythm | ✅ |
| AFIB | Atrial Fibrillation | ✅ |
| AFLU | Atrial Flutter | ✅ |
| AAT | Automatic Atrial Tachycardia | ✅ |
| MAT | Multifocal Atrial Tachycardia | ✅ |
| PAT | Paroxysmal Atrial Tachycardia | ✅ |
| AVD | AV Dissociation | ✅ |
| AVDI | AV Dissociation With Interference | ✅ |
| AV1 | First Degree AV Block | ✅ |
| AV2I | Second Degree AV Block Type I | ✅ |
| AV2II | Second Degree AV Block Type II | ✅ |
| AV3 | Third Degree AV Block | ✅ |
| RECP | AV Reciprocating Tachycardia | ✅ |
| RNTR | Reentrant AV Nodal Tachycardia | ✅ |
| JRYA | Accelerated AV Junctional (Nodal) Rhythm | ✅ |
| JRYE | AV Junctional (Nodal) Escape Rhythm | ✅ |
| JT | Junctional Tachycardia | ✅ |
| LGL | Lown-Ganong-Levine Syndrome | ✅ |
| SA2I | Second Degree SA Block Type I | ✅ |
| SA2II | Second Degree SA Block Type II | ✅ |
| SA3 | Third Degree SA Block | ✅ |
| ARHY | Sinus Arrhythmia | ✅ |
| SVT | Supraventricular Tachycardia (Atrial Or Junctional) | ✅ |
| TWA | T-Wave Alternans | ✅ |
| VAIR | Accelerated Idioventricular Rhythm | ❌ |
| VBI | Ventricular Bigeminy | ✅ |
| VFIB | Ventricular Fibrillation | ❌ |
| VFLU | Ventricular Flutter | ❌ |
| VRYI | Idioventricular (Ventricular Escape) Rhythm | ❌ |
| VTS | Slow Ventricular Tachycardia (Idioventricular Tachycardia) | ❌ |
| V2 | Ventricular Couplet | ❌ |
| VTNP | Ventricular Tachycardia (Nonparoxysmal) | ❌ |
| PAVT | Ventricular Tachycardia (Paroxysmal) | ❌ |
| PLVT | Polymorphic Ventricular Tachycardia | ❌ |
| VTDP | Torsades De Pointes Ventricular Tachycardia | ❌ |
| VTRG | Ventricular Trigeminy | ✅ |
| WSP | Wandering Sinus Pacemaker Within The Sinus Node | ✅ |
| WPWA | Wolff-Parkinson Type A | ✅ |
| WPWB | Wolff-Parkinson Type B | ✅ |
| VPCI | Ventricular Interpolated Beat | ❌ |
| A2 | Atrial Couplet | ✅ |
| ARYL | Lower Atrial Rhythm | ✅ |
| ARYM | Middle Atrial Rhythm | ✅ |
| ARYU | Upper Atrial Rhythm | ✅ |
| ATRG | Atrial Trigeminy | ✅ |
| A3 | Atrial Triplet | ✅ |
| JBI | Junctional Bigeminy | ✅ |
| J2 | Junctional Couplet | ✅ |
| JTRG | Junctional Trigeminy | ✅ |
| J3 | Junctional Triplet | ✅ |
| V3 | Ventricular Triplet | ❌ |
| BBB | Bundle Branch Block Beat | |
| (Unspecified) | ❌ | |
| BBTI | Trifascicular Block Beat | ❌ |
| LBBI | Incomplete Left Bundle Branch Block Beat | ❌ |
| SVE | Supraventricular Escape Beat (Least Specific) | ✅ |
| SVPC | Supraventricular Premature Contraction | ✅ |
| ZZZ | Noise (No Signal) | ❌ |
| AT | Atrial Tachycardia | ✅ |
| AVDC | Complete AV Dissociation | ✅ |
| AVDS | Isorhythmic AV Dissociation | ✅ |
| AV2 | Second Degree AV Block | ✅ |
| BRDY | Bradycardia Of Any Type | ✅ |
| JRY | Av Junctional (Nodal) Rhythm | ✅ |
| LHRV | Low Heart Rate Variability | ✅ |
| PREX | Pre-Excitation | ✅ |
| BRDY | Sinus Bradycardia | ✅ |
| SRHY | Normal Sinus Rhythm | ✅ |
| TAHY | Sinus Tachycardia | ✅ |
| SVE | Supraventricular (Atrial Or Junctional) Ectopic Rhythm | ✅ |
| SVTP | Supraventricular Paroxysmal Tachycardia | ✅ |
| VRUN | Ventricular Run | ❌ |
| VPAR | Ventricular Parasystole | ❌ |
| VRY | Ventricular Rhythm | ❌ |
| MOVT | Monomorphic Ventricular Tachycardia | ❌ |
| WAP | Wandering Pacemaker From The Sinus Node To (And From) The A-V Node | ✅ |
| WPW | Wolff-Parkinson-White Syndrome | ❌ |
| A | Artifact | ❌ |