Right bundle branch block natural history, complications and prognosis

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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]

Natural History

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:

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 ventricular arrhythmias and sudden death.

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.

• Ventricular arrhythmias
• Sudden cardiac death
• RBBB can delay the accurate diagnosis of heart attack