Diagnostic Considerations

Important considerations

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.

Other problems to be considered

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

Left Bundle Branch Block
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 preexcitation)
Brugada syndrome
Arrhythmogenic right ventricle cardiomyopathy (ARVC)

Workup

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Media Gallery

Pediatric Right Bundle Branch Block. These electrocardiographs demonstrate a normal sinus rhythm and a sinus rhythm with a right bundle branch block.
Pediatric Right Bundle Branch Block. Anatomy of the penetrating portion of the atrioventricular (AV) bundle is shown.
Pediatric Right Bundle Branch Block. This image depicts the electrophysiologic events of right bundle branch block. AV = atrioventricular.
Pediatric Right Bundle Branch Block. Pathophysiology of right bundle branch block is described. AV = atrioventricular; LV = left ventricular; RV = right ventricular.
Pediatric Right Bundle Branch Block. This image depicts the electrophysiologic sequence of events that occur in normal cardiac conduction. AV = atrioventricular.
Pediatric Right Bundle Branch Block. This image demonstrates a wide S wave.

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Author

Glenn T Wetzel, MD, PhD Associate Professor of Pediatric Cardiology, John Hopkins University School of Medicine; Director, Pediatric Interventional Electrophysiology, John Hopkins Children's Center

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

Disclosure: Nothing to disclose.

Coauthor(s)

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.

Karine Guerrier, DO, MPH Assistant Professor, Division of Cardiology, Department of Pediatrics, University of Tennessee Health Science Center College of Medicine; Director, Cardiac Rhythm Device Management, Le Bonheur Heart Institute, Le Bonheur Children’s Hospital

Karine Guerrier, DO, MPH is a member of the following medical societies: American College of Cardiology, American Heart Association, Heart Rhythm Society, Pediatric and Congenital Electrophysiology Society

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

Disclosure: Nothing to disclose.

Chief Editor

Syamasundar Rao Patnana, 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

Syamasundar Rao Patnana, 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.

Acknowledgements

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.