Pediatric Right Bundle Branch Block Differential Diagnoses

  • Author: Glenn T Wetzel, MD, PhD; Chief Editor: P Syamasundar Rao, MD  more...
Updated: Jul 24, 2015

Diagnostic ConsiderationsImportant considerationsOther problems to be considered

Although the risk of right bundle branch block (RBBB) progressing to complete heart block and sudden death is low, patients require workup and consultation with a pediatric cardiologist.

Failure to have the child properly evaluated could result in an unnecessary death and the legal ramifications resulting from such a tragedy.

In patients with suspected RBBB, also consider the following in the differential diagnosis:

  • Interventricular conduction delay
  • Right bundle branch aberrancy (premature atrial contractions, supraventricular tachycardia)
  • Premature ventricular contractions and other ventricular arrhythmia
  • Paced ventricular beat
  • Wolff-Parkinson-White syndrome (ventricular pre-excitation)
  • Brugada syndrome
  • Arrhythmogenic right ventricle cardiomyopathy (ARVC)
Contributor Information and Disclosures

Glenn T Wetzel, MD, PhD Professor of Pediatrics, University of Tennessee College of Medicine; Director, Pediatric Arrhythmia Service, Le Bonheur Children's Hospital

Glenn T Wetzel, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, Heart Rhythm Society

Disclosure: Nothing to disclose.


Kenneth R Knecht, MD Assistant Professor of Cardiology, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences College of Medicine

Kenneth R Knecht, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Alvin J Chin, MD Emeritus Professor of Pediatrics, University of Pennsylvania School of Medicine

Alvin J Chin, MD is a member of the following medical societies: American Association for the Advancement of Science, Society for Developmental Biology, American Heart Association

Disclosure: Nothing to disclose.

Chief Editor

P Syamasundar Rao, MD Professor of Pediatrics and Medicine, Division of Cardiology, Emeritus Chief of Pediatric Cardiology, University of Texas Medical School at Houston and Children's Memorial Hermann Hospital

P Syamasundar Rao, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, American College of Cardiology, American Heart Association, Society for Cardiovascular Angiography and Interventions, Society for Pediatric Research

Disclosure: Nothing to disclose.

Additional Contributors

Christopher Johnsrude, MD, MS Chief, Division of Pediatric Cardiology, University of Louisville School of Medicine; Director, Congenital Heart Center, Kosair Children's Hospital

Christopher Johnsrude, MD, MS is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology

Disclosure: Nothing to disclose.


The authors and editors of Medscape Drugs & Diseases gratefully acknowledge the contributions of previous authors Christopher Mart, MD; Kerry Rosen, MD; and Christopher Zachary, MD, to the development and writing of this article.

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ECGs demonstrate a normal sinus rhythm and a sinus rhythm with a right bundle branch block.
Anatomy of the penetrating portion of the atrioventricular (AV) bundle.
ECG depicts electrophysiologic events of right bundle branch block. AV = atrioventricular.
Pathophysiology of right bundle branch block. AV = atrioventricular; LV = left ventricular; RV = right ventricular.
ECG depicts electrophysiologic sequence of events that occur in normal cardiac conduction. AV = atrioventricular.
ECG demonstrates a wide S wave.
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