Right bundle branch block overview

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

Right bundle branch block (RBBB) results from a defect in the heart's electrical conduction system. There is a delay in failure of transmission of electrical impulses down the right bundle of the heart. As a result, the right ventricle depolarizes by an alternate mechanism. This is by means of cell-to-cell conduction. These cell to cell conduction impulses spread more slowly than usual from the interventricular septum to the left ventricle and to the right ventricle. This delay in conduction results in the characteristic ECG pattern which is a wide and notched QRS. Although conduction down the right bundle is delayed, conduction down the left bundle is normal. As a result, the interventricular septum and left ventricle depolarize in the normal fashion.

Epidemiology and Demographics

Prevalence of RBBB increases with age.

Diagnosis

Physical Examination

Right bundle branch block is associated with a persistently split second heart sound with normal respiratory variation in the splitting interval.

Laboratory Findings

If there is a history of blunt trauma or any symptoms to suggest polymyositis, then troponin, creatine kinase (CK) and an echocardiogram should be obtained.

Electrocardiogram

Criteria for complete right bundle branch block include: a QRS duration of > .12 seconds, an rSR' pattern with a wide terminal R wave in V1 and a qRS complex with a wide S wave in V6.

Treatment

Medical Therapy

In general treatment for right bundle branch block is not necessary. These patients need not limit their activity. However, if the RBBB progresses to heart block, the patient may be at risk for adverse clinical outcomes. In these patients further electrophysiologic testing may be necessary. Those patients who develop right bundle branch block after surgery should undergo EKG testing each year to evaluate for interval changes. In particular, care should be taken to observe for the development of sinus bradycardia supraventricular or ventricular ectopy.

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