Right bundle branch block natural history, complications and prognosis: Difference between revisions

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{{Right bundle branch block}}
{{Right bundle branch block}}
{{CMG}} {{AE}} {{CZ}}, {{AN}}, {{RT}}
{{CMG}} {{AE}} {{CZ}}; {{AN}}; {{RT}}
 
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==Natural History==
==Natural History==
Right bundle branch block may progress to [[complete heart block]] and [[sudden death]] if it is accompanied with higher grades of injuries to the conduction system, like [[first degree AV block]] and injury to the [[His-Purkinje system]] leading to a [[left anterior hemiblock]].
Right bundle branch block may progress to [[complete heart block]] and [[sudden death]] if it is accompanied with higher grades of injuries to the conduction system, like [[first degree AV block]] and injury to the [[His-Purkinje system]] leading to a [[left anterior hemiblock]].


In general, the natural history of right bundle branch block is benign. There are three scenarios in which right bundle branch block can be associated with poor [[prognosis]]:
In general, the natural history of right bundle branch block is benign. If right bundle branch block is due to surgery then there are generally no acute [[hemodynamic]] consequences.  The subsequent courses also quite benign.  An exception is if there is substantial injury to the [[His-Purkinje system]] in which case [[left anterior hemiblock]] or [[first-degree AV block]] may be present.
#[[Brugada syndrome]]: If right bundle branch block is present, then [[sudden death]] may occur.
#[[Kearns Sayre syndrome]]: Again, if right bundle branch block is present than [[sudden death]] may occur.
#[[Tetralogy of Fallot]]:  If right bundle branch block is present with a markedly prolonged [[QRS]] (> 180 ms), then the patient may be at risk for ventricular [[arrhythmias]] and [[sudden death]].
#[[Arrhythmogenic right ventricular cardiomyopathy]]: Risk of sudden death is higher.
 
If right bundle branch block is due to surgery then there are generally no acute [[hemodynamic]] consequences.  The subsequent courses also quite benign.  An exception is if there is substantial injury to the [[His-Purkinje system]] in which case [[left anterior hemiblock]] or [[first-degree AV block]] may be present.


There are familial cases of right bundle branch block, which are [[benign]].
There are familial cases of right bundle branch block, which are [[benign]].
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* [[Sudden cardiac death]]
* [[Sudden cardiac death]]
* RBBB can delay the accurate diagnosis of [[heart attack]]
* RBBB can delay the accurate diagnosis of [[heart attack]]


==Prognosis==
==Prognosis==
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* Patients who have type II second degree atrioventricular block or multi-fascicular block along with RBBB have a poor prognosis compared to those without RBBB and such patients are also known to have a more significant myocardial disease.  
* Patients who have type II second degree atrioventricular block or multi-fascicular block along with RBBB have a poor prognosis compared to those without RBBB and such patients are also known to have a more significant myocardial disease.  
* The Copenhagen City Heart Study showed that RBBB is associated with a significant increase in all-cause and cardiovascular mortality in both genders<ref name="pmid22947613">{{cite journal |author=Bussink BE, Holst AG, Jespersen L, Deckers JW, Jensen GB, Prescott E |title=Right bundle branch block: prevalence, risk factors, and outcome in the general population: results from the Copenhagen City Heart Study |journal=Eur. Heart J. |volume=34 |issue=2 |pages=138–46 |year=2013 |month=January |pmid=22947613 |doi=10.1093/eurheartj/ehs291 |url=}}</ref>.  
* The Copenhagen City Heart Study showed that RBBB is associated with a significant increase in all-cause and cardiovascular mortality in both genders<ref name="pmid22947613">{{cite journal |author=Bussink BE, Holst AG, Jespersen L, Deckers JW, Jensen GB, Prescott E |title=Right bundle branch block: prevalence, risk factors, and outcome in the general population: results from the Copenhagen City Heart Study |journal=Eur. Heart J. |volume=34 |issue=2 |pages=138–46 |year=2013 |month=January |pmid=22947613 |doi=10.1093/eurheartj/ehs291 |url=}}</ref>.  
 
* There are three scenarios in which right bundle branch block can be associated with poor[[prognosis]]:
# [[Brugada syndrome]]: If right bundle branch block is present, then [[sudden death]] may occur.
# [[Kearns Sayre syndrome]]: Again, if right bundle branch block is present than [[sudden death]] may occur.
# [[Tetralogy of Fallot]]:  If right bundle branch block is present with a markedly prolonged [[QRS]] (> 180 ms), then the patient may be at risk for ventricular[[arrhythmias]] and [[sudden death]].
# [[Arrhythmogenic right ventricular cardiomyopathy]]: Risk of sudden death is higher.


==References==
==References==

Revision as of 16:19, 12 April 2013

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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]; Aarti Narayan, M.B.B.S [3]; Raviteja Guddeti, M.B.B.S. [4]

Natural History

Right bundle branch block may progress to complete heart block and sudden death if it is accompanied with higher grades of injuries to the conduction system, like first degree AV block and injury to the His-Purkinje system leading to a left anterior hemiblock.

In general, the natural history of right bundle branch block is benign. If right bundle branch block is due to surgery then there are generally no acute hemodynamic consequences. The subsequent courses also quite benign. An exception is if there is substantial injury to the His-Purkinje system in which case left anterior hemiblock or first-degree AV block may be present.

There are familial cases of right bundle branch block, which are benign.

Complications

Complication rate is higher in patients who have myocardial infarction and develop a new RBBB compared to those who have heart attack and not develop a new RBBB.

Prognosis

  • Isolated right bundle branch block without underlying heart disease has an excellent prognosis.
  • In the presence of a known underlying heart disease, especially coronary artery disease, complete RBBB is associated with increased mortality.
  • RBBB in the setting of acute myocardial infarction is associated with increased mortality even after the initiation of thrombolytic therapy.
  • Studies have shown that RBBB is associated with worse outcomes in the long run in patients with established heart failure.
  • Patients who have type II second degree atrioventricular block or multi-fascicular block along with RBBB have a poor prognosis compared to those without RBBB and such patients are also known to have a more significant myocardial disease.
  • The Copenhagen City Heart Study showed that RBBB is associated with a significant increase in all-cause and cardiovascular mortality in both genders[1].
  • There are three scenarios in which right bundle branch block can be associated with poorprognosis:
  1. Brugada syndrome: If right bundle branch block is present, then sudden death may occur.
  2. Kearns Sayre syndrome: Again, if right bundle branch block is present than sudden death may occur.
  3. Tetralogy of Fallot: If right bundle branch block is present with a markedly prolonged QRS (> 180 ms), then the patient may be at risk for ventriculararrhythmias and sudden death.
  4. Arrhythmogenic right ventricular cardiomyopathy: Risk of sudden death is higher.

References

  1. ↑ Bussink BE, Holst AG, Jespersen L, Deckers JW, Jensen GB, Prescott E (2013). "Right bundle branch block: prevalence, risk factors, and outcome in the general population: results from the Copenhagen City Heart Study". Eur. Heart J. 34 (2): 138–46. doi:10.1093/eurheartj/ehs291. PMID 22947613. Unknown parameter |month= ignored (help)

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