Right Bundle Branch Block (RBBB)

When Is RBBB A Problem?

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Right bundle branch block (RBBB) is a distinctive pattern seen on the electrocardiogram (ECG) that occurs when the cardiac electrical impulse is interrupted as it spreads across the ventricles of the heart.

Bundle Branch Block

The bundle branches are the electrical pathways that allow the heart’s electrical impulse to spread rapidly and evenly through the ventricles, so that the contraction of the heart is well coordinated.

There are two main bundle branches - the right (which distributes the electrical impulse across the right ventricle) and the left (which distributes the impulse across the left ventricle).

Bundle branch block occurs when one or both of the main bundle branches are partially or completely blocked. There are two main types of bundle branch block, namely, left or right bundle branch block.

Right Bundle Branch Block

RBBB is a more common, and much less significant, ECG finding than left bundle branch block (LBBB). While RBBB in not common in young people, the incidence increases with age. More than 11% of 80-year-olds have RBBB.

If your doctor tells you that you have RBBB, then an evaluation should be done to make sure you do not have an underlying heart or lung condition. If no such medical condition is present, then your RBBB generally can be considered benign (not harmful).

RBBB and Underlying Heart and Lung Disease

The reason RBBB is not as uncommon as LBBB is that the right bundle branch, as it courses within the muscle of the right ventricle, is relatively superficial (that is, near the surface of the ventricular cavity) for much of its length. This makes it susceptible to damage and stretching whenever the right ventricle is placed under stress of any kind.

RBBB often occurs in any condition that affects the right ventricle. These conditions can include coronary artery disease (CAD), myocarditis (inflammation of the cardiac muscle), atrial septal defect, ventricular septal defect, and valvular heart disease. RBBB may also be a result of any lung condition that causes a chronic elevation in the pressures of the right ventricle - typically, this is seen in some types of chronic obstructive pulmonary disease (COPD).

Furthermore, RBBB is common with any condition that acutely raises pressures in the right ventricle. The most common condition that does this is pulmonary embolus.

What this means is that if you are discovered to have RBBB, your doctor should take a careful medical history and perform a full physical examination (concentrating on signs of heart and lung disease), and often should consider ordering an echocardiogram to look for unapparent heart disease.

Because the right bundle branch is susceptible to anything that can produce even small trauma in the right ventricle, transient RBBB occurs in approximately 5% of patients undergoing cardiac catheterization.

This temporary RBBB occurs when the catheter irritates the right bundle branch. The RBBB usually resolves quickly when the catheter is removed. However, in patients who already have LBBB, causing temporary RBBB like this will create complete heart block - and the heart can stop beating. So in patients who have LBBB and who are having a cardiac catheterization study, sometimes a temporary pacemaker is inserted during the procedure, to assure that the heart rhythm will continue uninterrupted during the study.

RBBB and the Efficiency of the Heartbeat

With either type of BBB, the heart's two ventricles are being stimulated in sequence (one after the other) instead of simultaneously. This loss of normal coordination between the two ventricles can reduce the efficiency of the heart beat. However, the reduction in the heart's efficiency is far less pronounced in RBBB than it is in LBBB, and many experts believe that RBBB causes no measurable loss of efficiency at all.

Because LBBB is associated with a loss of cardiac efficiency, it is currently recommended that many patients who have LBBB along with heart failure should receive cardiac resynchronization therapy (CRT). (CRT is a type of pacemaker that re-coordinates the contraction of the ventricles to improve cardiac efficiency.) But while CRT can produce a significant improvement in cardiac function in heart failure patients with LBBB, there is no evidence that CRT helps very much with RBBB.


RBBB is itself a benign condition that requires no treatment. However, if you are found to have RBBB, you should talk with your doctor about performing a screening evaluation for underlying heart or lung disease. If none is found, then your RBBB can be written off as an incidental finding with no important medical significance.


Eriksson P, Wilhelmsen L, Rosengren A. Bundle-branch block in middle-aged men: risk of complications and death over 28 years. The Primary Prevention Study in Göteborg, Sweden. Eur Heart J 2005; 26:2300.

Barsheshet A, Goldenberg I, Garty M, et al. Relation of bundle branch block to long-term (four-year) mortality in hospitalized patients with systolic heart failure. Am J Cardiol 2011; 107:540.

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