In the majority of cases, right bundle branch block produces no symptoms of the heart condition. The more common sign and symptoms encountered in RBBB includes:
The following tests and diagnostic modalities are implored in the diagnosis of right bundle branch blocks:
Patients presenting with asymptomatic heart block or a first degree heart block do not require any treatment. However, in RBBB presenting with an underlying condition, treatment may be necessary to control the disorder.
These may require the intake of medications to control hypertension or diabetes as the primary underlying cause. An invasive coronary angioplasty may be done to repair the blocked coronary arteries to relieve the impending RBBB.
In patients presenting with recurrent fainting, the implantation of an internal pacemaker may prevent further fainting spells. The pacemaker will generate regular electric impulses to regulate heart rhythm and ensure an optimal cardiac pumping.
Some forms of naturally occurring right bundle branch block like familial bundle branch block has a good prognostic outcome. Post VSD repair scarring of heart tissues may present eminently of electrophysiologic studies but may prove to be benign in the long run. However, cardiac scarring due to the tetralogy of Fallot repair have increases risk of cardiac arrhythmia and sudden cardiac death.
ECG finding of right bundle branch block associated with the Brugada syndrome , arrhythmogenic right ventricular cardiomyopathy (ARVC) , and Kearne-Sayre syndrome are also at high risk with sudden cardiac death and arrhythmia; thus, carry a grim prognosis in patients .
The following cardiac conditions are common complications associated with the right bundle branch block:
The following medical conditions can directly cause right bundle branch block in patients:
In the United States, the most common cause of right bundle branch block among children is post-surgical repair scarring of ventricular septal defect (VSD). The incidence rate for RBBB in the surgical repair of VSD alone is 25-81% and up to 60-100% after surgical cardiac repair in tetralogy of Fallot.
The long term effect of surgically induced RBBB in VSD repair has no major hemodynamic significance on the patient. However, in patients who underwent repair of the tetralogy of Fallot may consequently have QRS prolongation of up to 180 milliseconds and may carry some risk for arrhythmia and sudden cardiac death.
A number of trained athletes my present with complete and incomplete RBBB by voltage that points to an innocent physiologic cardiac remodeling phenomenon of the right atrium .
The basic pathophysiological defect in right bundle branch block is primarily due to the non-conduction of electrical impulses from the bundle of His to right bundle branch tracks.
In the advent that the left bundle branch conducts normally, right ventricular depolarization becomes significantly discordant with the left ventricle. This ventricular depolarization mismatch gives out the characteristic electrocardiograph (ECG) reading. There are rare cases of exercise induced right bundle branch block which are presenting similarly but are clinically benign .
Not all right bundle branch block conditions are preventable. However, RBBB can effectively be prevented by keeping the heart healthy to avert cardiac conditions that results to RBBB. The following useful tips can reduce the risk for coronary artery disease that can lead to RBBB:
Right bundle branch block (RBBB) refers to a clinical condition wherein the transmission of impulses towards the right ventricle is significantly delayed. The blockage of the right sided electrical pathway can make it difficult for the heart to pump efficiently. There are no specific treatment for RBBB and all management is geared towards the resolution of the underlying cardiac disease.
Electrocardiography, echocardiography, and Holter monitoring may be necessary to diagnose the condition.
Treatment and follow-up
Management of underlying cardiac cause and pacemaker installation are common treatment options.