Pediatric Right Bundle Branch Block Clinical Presentation

Updated: Jan 24, 2022
  • Author: Glenn T Wetzel, MD, PhD; Chief Editor: Syamasundar Rao Patnana, MD  more...
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History and Physical Examination


The history in children with right bundle branch block (RBBB) should include the following:

  • History of congenital heart disease

  • History of cardiac surgery

  • History of palpitations, general energy and activity level, exercise tolerance, dizziness, and/or syncope

  • Family history of known arrhythmias, including bundle branch block, complete heart block, and placement of a pacemaker or defibrillator

  • Family history of premature or sudden unexplained death, myocardial infarction in individuals younger than 45 years, [19] syncope, seizures, or fetal loss

Physical examination

Upon physical examination, patients with right bundle branch block have a persistently split second heart sound with normal respiratory variation in the splitting interval. In addition, one should always evaluate for findings consistent with postoperative heart disease, such as murmurs or a thoracotomy scar.