eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Cardiology

Bundle Branch Block, Right: Follow-up

Author: Glenn T Wetzel, MD, PhD, Professor of Pediatrics, University of Tennessee College of Medicine; Director, Pediatric Arrhythmia Service, Le Bonheur Children's Medical Center
Coauthor(s): Kenneth R Knecht, MD, Fellow, Department of Pediatrics, Division of Pediatric Cardiology, University of Tennessee Health Science Center
Contributor Information and Disclosures

Updated: Aug 25, 2008

Follow-up

Further Inpatient Care

  • Inpatient ECG telemetry may be required if patients with right bundle branch block (RBBB) are at risk for clinically significant arrhythmia (see Natural history).

Further Outpatient Care

  • Individuals with heart disease treated or not treated with surgery and those with right bundle branch block should undergo ECG each year to evaluate for interval changes.
  • In these individuals, ECGs may reveal progression of the underlying conduction defect or other potential rhythm abnormalities (eg, sinus bradycardia, supraventricular or ventricular ectopy).

Complications

  • If right bundle branch block progresses to heart block, the patient may have fatigue, exercise intolerance, dizziness, syncope, or sudden death.
  • Some patients who have undergone tetralogy of Fallot repair and have a right bundle branch block pattern and a markedly prolonged QRS may be at increased risk for ventricular tachycardia or sudden death.

Prognosis

  • The prognosis for patients with isolated right bundle branch block is excellent because the course of right bundle branch block is generally benign.
  • In other patients with right bundle branch block, such as those who have undergone heart transplantation or repair of congenital heart disease and those with Brugada syndrome, Kearns-Sayre syndrome, myocarditis, or cardiomyopathy, the prognosis depends on the underlying condition causing the right bundle branch block.

Patient Education

  • Patients, parents, and primary medical providers should be informed that right bundle branch block per se does not typically predict specific future problems or management concerns.
  • For excellent patient education resources, visit eMedicine's Heart Center. Also, see eMedicine's patient education article Tetralogy of Fallot.

Miscellaneous

Medicolegal Pitfalls

  • 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.
 
Acknowledgments

The authors and editors of eMedicine 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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References
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Further Reading

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Keywords

right bundle branch block, RBBB, electrocardiography, electrocardiogram, ECG, EKG, heart block, bundle branch block, BBB, QRS complex, tetralogy of Fallot repair, TOF repair, surgically induced RBBB, familial RBBB, proximal RBBB, central RBBB, distal RBBB, Wolff-Parkinson-White syndrome, WPW, ventricular septal defect, Brugada syndrome, double-chambered right ventricle, atrioventricular, AV canal, tetralogy of Fallot, left anterior hemiblock, sudden death, ventricular tachycardia, exercise tolerance, dizziness, syncope, cardiomyopathy, myocarditis, congestive heart failure, atrial septal defect, ASD, Ebstein anomaly, mitral valve prolapse, pulmonary flow murmur, myotonic dystrophy, muscular dystrophy, myotonias, hypogonadism, frontal balding, cataracts, first-degree atrioventricular block, left anterior fascicular block, intraventricular conduction delay

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Contributor Information and Disclosures

Author

Glenn T Wetzel, MD, PhD, Professor of Pediatrics, University of Tennessee College of Medicine; Director, Pediatric Arrhythmia Service, Le Bonheur Children's Medical Center
Glenn T Wetzel, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Heart Association, Heart Rhythm Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Coauthor(s)

Kenneth R Knecht, MD, Fellow, Department of Pediatrics, Division of Pediatric Cardiology, University of Tennessee Health Science Center
Kenneth R Knecht, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Medical Editor

Christopher Johnsrude, MD, Associate Professor of Pediatrics, Director of Electrophysiology, University of Louisville School of Medicine; Consulting Staff, Pediatric Cardiology Associates, PSC
Christopher Johnsrude, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Cardiology
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Alvin J Chin, MD, Professor of Pediatrics, Division of Cardiology, The Children's Hospital of Philadelphia, 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 and American Heart Association
Disclosure: Nothing to disclose.

CME Editor

Gilbert Herzberg, MD, Assistant Professor, Department of Pediatrics, Section of Pediatric Cardiology, New York Medical College
Gilbert Herzberg, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Chief Editor

Steven R Neish, MD, SM, Director of Pediatric Cardiology Fellowship Program, Associate Professor, Department of Pediatrics, Baylor College of Medicine
Steven R Neish, MD, SM is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, and American Heart Association
Disclosure: Nothing to disclose.

 
 
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