What is the prevalence of pediatric right bundle branch block in the US?

Updated: Jul 26, 2018
  • Author: Glenn T Wetzel, MD, PhD; Chief Editor: Syamasundar Rao Patnana, MD  more...
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Answer

The most common cause of right bundle branch block in children is surgery associated with repair of an isolated ventricular septal defect (VSD) or another congenital heart disease that includes a VSD (eg, double-chambered right ventricle, atrioventricular [AV] canal, or tetralogy of Fallot). The incidence of right bundle branch block ranges from 25%-81% after repair of a VSD alone to 60%-100% after repair of tetralogy of Fallot. The variation of right bundle branch block after surgery is likely due to the proximity of the VSD to the His bundle and right bundle, as well as the surgical technique. For example, right bundle branch block is less common with transatrial repair or exclusion ventriculotomy repair of a VSD than with other procedures.

Age-related demographics

Surgical repair of tetralogy of Fallot, in addition to closing the VSD, is often associated with a transannular patch of the right ventricular outflow tract. This situation often results in clinically significant pulmonic valve insufficiency and progressive right ventricular dilatation as the patient ages. In addition, some patients have residual stenosis at various levels in the pulmonary outflow tract. By the time the patient is in his or her late teens or young adulthood, the right ventricle has been subjected to years of abnormal hemodynamics. As noted above, patients with right bundle branch block and a markedly prolonged QRS duration (>180 ms) may be at increased risk for ventricular tachycardia and sudden death.


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