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Current Cardiology Reviews

Editor-in-Chief

ISSN (Print): 1573-403X
ISSN (Online): 1875-6557

Review Article

Right Bundle Branch Block: Current Considerations

Author(s): Takanori Ikeda*

Volume 17, Issue 1, 2021

Published on: 08 July, 2020

Page: [24 - 30] Pages: 7

DOI: 10.2174/1573403X16666200708111553

Price: $65

Abstract

RBBB, a pattern seen on the 12-lead ECG, results when normal electrical activity in the His-Purkinje system is interrupted for some reason. The normal sequence of activation is altered in RBBB, with a resultant characteristic appearance on the ECG manifest by a widened QRS complex and changes in the directional vectors of the R and S waves. This ECG pattern is often seen in clinical practice and generally regarded as benign. The anatomy, epidemiology, causes, symptoms, ECG findings and diagnosis, differential diagnosis in ECG, treatment, complications, prognosis, with respect to RBBB are outlined here, demonstrating some typical ECGs of RBBB.

Keywords: Right bundle branch block, His-Purkinje system, widened QRS complex, conduction disturbance, ECG, 12-lead.

Graphical Abstract
[1]
Josephson ME. Clinical Cardiac Electrophysiology: Techniques and Interpretations, 2nd. Philadelphia: Lea & Febiger 1993.
[2]
Watt TB Jr, Pruitt RD. Focal lesions in the canine bundle of His. Their effect on ventricular excitation. Circ Res 1972; 31(4): 531-45.
[http://dx.doi.org/10.1161/01.RES.31.4.531] [PMID: 5075374]
[3]
Eriksson P, Hansson PO, Eriksson H, Dellborg M. Bundle-branch block in a general male population: the study of men born 1913. Circulation 1998; 98(22): 2494-500.
[http://dx.doi.org/10.1161/01.CIR.98.22.2494] [PMID: 9832497]
[4]
Bussink BE, Holst AG, Jespersen L, Deckers JW, Jensen GB, Prescott E. Right bundle branch block: prevalence, risk factors, and outcome in the general population: results from the Copenhagen City Heart Study. Eur Heart J 2013; 34(2): 138-46.
[http://dx.doi.org/10.1093/eurheartj/ehs291] [PMID: 22947613]
[5]
Zhang ZM, Rautaharju PM, Soliman EZ, et al. Mortality risk associated with bundle branch blocks and related repolarization abnormalities (from the Women’s Health Initiative [WHI]). Am J Cardiol 2012; 110(10): 1489-95.
[http://dx.doi.org/10.1016/j.amjcard.2012.06.060] [PMID: 22858187]
[6]
Badheka AO, Singh V, Patel NJ, et al. QRS duration on electrocardiography and cardiovascular mortality (from the National Health and Nutrition Examination Survey-III). Am J Cardiol 2013; 112(5): 671-7.
[http://dx.doi.org/10.1016/j.amjcard.2013.04.040] [PMID: 23726176]
[7]
Hiss RG, Lamb LE. Electrocardiographic findings in 122,043 individuals. Circulation 1962; 25: 947-61.
[http://dx.doi.org/10.1161/01.CIR.25.6.947] [PMID: 13907778]
[8]
Rotman M, Triebwasser JH. A clinical and follow-up study of right and left bundle branch block. Circulation 1975; 51(3): 477-84.
[http://dx.doi.org/10.1161/01.CIR.51.3.477] [PMID: 1132086]
[9]
Miller WL, Hodge DO, Hammill SC. Association of uncomplicated electrocardiographic conduction blocks with subsequent cardiac morbidity in a community-based population (Olmsted County, Minnesota). Am J Cardiol 2008; 101(1): 102-6.
[http://dx.doi.org/10.1016/j.amjcard.2007.07.056] [PMID: 18157974]
[10]
Surawicz B, Childers R, Deal BJ, et al. American Heart Association Electrocardiography and Arrhythmias Committee. Council on Clinical Cardiology; American College of Cardiology Foundation; Heart Rhythm Society; Endorsed by the International Society for Computerized Electrocardiology. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part III: intraventricular conduction disturbances: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. J Am Coll Cardiol 2009; 53(11): 976-81.
[http://dx.doi.org/10.1016/j.jacc.2008.12.013] [PMID: 19281930]
[11]
Wagner GS, Macfarlane P, Wellens H, et al. American Heart Association Electrocardiography and Arrhythmias Committee. Council on Clinical Cardiology; American College of Cardiology Foundation; Heart Rhythm Society; Endorsed by the International Society for Computerized Electrocardiology. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part VI: acute ischemia/infarction: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. J Am Coll Cardiol 2009; 53(11): 1003-11.
[http://dx.doi.org/10.1016/j.jacc.2008.12.016] [PMID: 19281933]
[12]
Ikeda T. Brugada syndrome: current clinical aspects and risk stratification. Ann Noninvasive Electrocardiol 2002; 7(3): 251-62.
[http://dx.doi.org/10.1111/j.1542-474X.2002.tb00172.x] [PMID: 12167188]
[13]
Atwater BD, Wagner GS, Kisslo J, Risum N. The electromechanical substrate for response to cardiac resynchronization therapy in patients with right bundle branch block. Pacing Clin Electrophysiol 2017; 40(12): 1358-67.
[http://dx.doi.org/10.1111/pace.13231] [PMID: 29086988]
[14]
Houston BA, Sturdivant JL, Yu Y, Gold MR. Acute biventricular hemodynamic effects of cardiac resynchronization therapy in right bundle branch block. Heart Rhythm 2018; 15(10): 1525-32.
[http://dx.doi.org/10.1016/j.hrthm.2018.05.017] [PMID: 29800750]
[15]
Chiale PA, Garro HA, Fernández PA, Elizari MV. High-degree right bundle branch block obscuring the diagnosis of Brugada electrocardiographic pattern. Heart Rhythm 2012; 9(6): 974-6.
[http://dx.doi.org/10.1016/j.hrthm.2012.01.028] [PMID: 22306100]
[16]
Baranchuk A, Barbosa-Barros R, Pérez-Riera AR. Brugada ECG pattern obscured by right bundle branch block: how to resolve the enigma? Pacing Clin Electrophysiol 2014; 37(8): 1071-2.
[http://dx.doi.org/10.1111/pace.12388] [PMID: 24665941]
[17]
Hesse B, Diaz LA, Snader CE, Blackstone EH, Lauer MS. Complete bundle branch block as an independent predictor of all-cause mortality: report of 7,073 patients referred for nuclear exercise testing. Am J Med 2001; 110(4): 253-9.
[http://dx.doi.org/10.1016/S0002-9343(00)00713-0] [PMID: 11239842]
[18]
Freedman RA, Alderman EL, Sheffield LT, Saporito M, Fisher LD. Bundle branch block in patients with chronic coronary artery disease: angiographic correlates and prognostic significance. J Am Coll Cardiol 1987; 10(1): 73-80.
[http://dx.doi.org/10.1016/S0735-1097(87)80162-6] [PMID: 3597997]
[19]
Barsheshet A, Goldenberg I, Garty M, et al. Relation of bundle branch block to long-term (four-year) mortality in hospitalized patients with systolic heart failure. Am J Cardiol 2011; 107(4): 540-4.
[http://dx.doi.org/10.1016/j.amjcard.2010.10.007] [PMID: 21184999]
[20]
Rasmussen PV, Skov MW, Ghouse J, et al. Clinical implications of electrocardiographic bundle branch block in primary care. Heart 2019; 105(15): 1160-7.
[http://dx.doi.org/10.1136/heartjnl-2018-314295] [PMID: 31129608]
[21]
Xiong Y, Wang L, Liu W, Hankey GJ, Xu B, Wang S. The prognostic significance of right bundle branch block: A meta-analysis of prospective cohort studies. Clin Cardiol 2015; 38(10): 604-13.
[http://dx.doi.org/10.1002/clc.22454] [PMID: 26436874]

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