Right bundle branch block pathophysiology
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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
Pathophysiology
Three types of RBBB have been identified based upon electrophysiologic studies.
In each of the three types of RBBB, the surface ECG pattern remains the same.
1. Proximal, or central, RBBB: This type of conduction defect occurs when the conduction block is located just distal to the bundle of His in the superior aspect of the right bundle branch. This type of block occurs when the proximal bundle is injured during surgery for an inlet or membranous ventricular septal defect (VSD).
2. Interruption between the proximal and distal aspects of the right bundle branch: This type of right bundle branch block occurs when the impulse is interrupted between the proximal and distal aspects of the right bundle branch. This type of bright bundle branch block is most commonly observed after surgical division of the moderator band.
3. Distal RBBB: This form is observed when distal ramifications of the right bundle are disrupted during right ventriculotomy or resection of muscle bundles in the right ventricular outflow tract.
Genetics
There can be familial cases of right bundle branch block such as that observed in 4 Lebanese families and the abnormality was mapped to chromosome 19.
There is a subset of patients with Brugada syndrome who have mutations in SCN5A, the gene encoding for the voltage-gated cardiac sodium channel.