Introduction: Within the QRS complex, the vector components either compete with each other or can appear at the same time. The two best examples of rewriting the original ECG curves are preexcitation and complete left bundle branch block. In contrast, the rS complex of left anterior hemiblock (LAH) and the Q wave of postero-inferior myocardial infarction (PI MI) can be observed simultaneously forming a W complex in the inferior leads. Methods: First, variants of incomplete right bundle branch blocks (IRBBB) were studied in healthy young adults and in patients with moderate pulmonary hypertension. According to the QRS morphology in the frontal plane (59 patients), three IRBBB patterns were formed: 1. SI-SII-SIII (n = 20); 2. SI-QIII (n = 18); 3. Both 1 and 2 patterns (n = 8). Presence or absence of IRBBB signs in lead V1 was meanwhile registered. Secondly, two further patterns were formed relating to comparison of biventricular incomplete blocks with arborization block. Both are characterized by depolarization inhomogeneity. 4. IRBBB + LAH (n = 11); 5. IRBBB + LAH + PI MI (n = 2). Results: In pattern 3, initial and terminal vectors (QIII-SIII) occurred simultaneously in the ECG lead III. Frequently, waves occurring in the same period of the depolarization in certain leads remained separable (two-component S-wave). In pattern 4, after the initial “r” wave, a two component S wave (rW complex) appeared in the inferior leads. Such separation of the depolarization vector components does not mean high electrical inhomogeneity if the width of QRS remains under 110 ms. In pattern 5, the ventricular depolarization is fragmented, and appears as three negative waves in the inferior leads (VW complex). In these cases, the duration of ventricular depolarization is also not wider than 110 ms. In contrast, the arborization block is characterized by fragmented depolarization, but the duration of QRS is wider than 140 ms, resulting in extreme inhomogeneity. Conclusion: By wave form analysis of biventricular incomplete blocks, we could describe a new ECG entity, of less dangerous “arborization block-like” form.
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