What are the risk factors for 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 children, most cases of right bundle branch block occur after intracardiac surgery, such as congenital heart surgery associated with repair of a ventricular septal defect (VSD) and tetralogy of Fallot, as well as cardiac transplantation. Right bundle branch block has also been described in patients undergoing cardiac catheterization, particularly transcatheter closure of perimembranous VSDs and catheter ablation for ventricular tachycardia.

Right bundle branch block has been associated with cardiomyopathy, myocarditis, congestive heart failure, right ventricular systolic dysfunction, [5] atrial septal defect (ASD), and Ebstein anomaly of the tricuspid valve.

A transient form of right bundle branch may be observed in patients with premature atrial contractions (Ashman phenomenon) or supraventricular tachycardia (rate dependent right bundle branch block). This occurs when an early impulse is conducted from the atrioventricular (AV) node to the His bundle while the right bundle branch is still refractory but the left bundle is not. Conduction down the right bundle branch is therefore delayed or blocked, resulting in a transient right bundle branch block pattern on the electrocardiogram (ECG).

Incomplete right bundle branch block has been described in children with perinatal exposure to human immunodeficiency virus (HIV) type 1. [6] In a more recent study that evaluated retrospective (2005-2014) Boston Children’s Hospital data from 32,127 ECGs depicting isolated right bundle branch conduction disturbances, the investigators noted that incomplete right bundle branch block is not uncommon in a healthy school age children, and that there was high inter-reader variability (its prevalence among readers ranged from 1% to 20%). [7]

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