What is the natural history of pediatric right bundle branch block?

Updated: Jul 26, 2018
  • Author: Glenn T Wetzel, MD, PhD; Chief Editor: Syamasundar Rao Patnana, MD  more...
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In general, surgically induced right bundle branch block results in no clinically significant acute hemodynamic consequences and has a benign course over the long term. In rare cases, a progression to complete heart block and sudden death is a concern, particularly if the right bundle branch block pattern is accompanied by additional evidence of substantial injury to the His-Purkinje system (eg, left anterior hemiblock, first-degree AV block). Patients who have undergone repair for tetralogy of Fallot and who have an right bundle branch block pattern with a markedly prolonged QRS duration (>180 ms) may be at increased risk for significant ventricular arrhythmias and sudden death.

Patients with right bundle branch block from other causes may have diverse natural histories depending on the underlying disease. The outcome may be benign in some forms of familial right bundle branch block, or sudden death may result if the right bundle branch block pattern on ECG is due to Brugada syndrome, arrhythmogenic right ventricular cardiomyopathy (ARVC), or Kearns-Sayre syndrome.

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