Right Bundle Branch Block

Right bundle branch block (RBBB) is a condition in your right bundle branch that makes your heartbeat signal late and out of sync with the left bundle branch. This creates an irregular heartbeat. Testing with an electrocardiogram (EKG/ECG) can find this.

Electrical signals in your heart control your heartbeats. A signal first tells your left and right atria (upper heart chambers) to contract. Next, the signal goes to your atrioventricular (AV) node and bundle branches, which make your left and right ventricles (lower heart chambers) tighten.

Normally, the signal goes down both bundle branches at once, and both ventricles work at the same time. But when you have RBBB, the signal has to go around the blockage. It must move through nearby heart muscle from the left ventricle to the right, which takes longer. This is why the right ventricle contracts later than the left one.

Many people have right bundle branch block, especially as they age. Nearly 2 out of 10 people have this by the time they’re 80. But it often doesn’t need treatment in people without other heart problems.

Types of this condition

Your healthcare provider may describe RBBB as:

• Complete RBBB: The signal takes 120 milliseconds (ms) or more to reach and activate the right ventricle. Complete RBBB increases your risk of heart attack and death if you already have heart disease.
• Incomplete RBBB: The signal takes between 100 and 120 ms to reach and activate the right ventricle. Incomplete RBBB is a more common type. It doesn’t increase your risk of heart attack and death.
• Rate-dependent RBBB: RBBB sometimes happens when you have a fast heart rate. It doesn’t happen when your heart rate is normal.

Symptoms of right bundle branch block

You most likely won’t have any RBBB symptoms. But you may have symptoms from other heart problems, like coronary artery disease or heart failure. These may include:

• Shortness of breath
• Chest pain
• Fatigue
• Swelling

Right bundle branch block causes

There are many RBBB causes, including:

• Inflamed heart muscle (myocarditis)
• Right-sided heart failure (cor pulmonale)
• Blood clot in your lung (pulmonary embolism)
• Heart disease
• Lack of blood flow to your heart muscle (ischemia) and/or heart attack
• Right heart catheterization or other heart procedures that use a catheter
• Cardiomyopathy (heart muscle disease)
• Heart valve disease
• Heart disease present at birth (congenital)
• Heart conduction defect (Lev’s Syndrome)

Risk factors

Right bundle branch block can happen in healthy people. It’s more likely to happen as you age, especially at age 60 and beyond. It’s also more common in men.

You may be able to lower your risk of RBBB if you can prevent the conditions that cause it.

How doctors diagnose this condition

A healthcare provider often finds right bundle branch block during an annual physical. An EKG can detect it. Your provider will see the shape of a two-finger peace sign in the QRS pattern that shows how long the signal takes to reach your right ventricle. The pattern looks like two points (the second higher than the first) with a deep “v” between them.

If you have RBBB, this pattern on an EKG shows that your heart’s lower chambers (ventricles) don’t beat together as they should. Instead, one beats after the other.

After making an RBBB diagnosis, your provider may request other tests if you have symptoms.

How is it treated?

Usually, if you don’t have symptoms and you don’t have heart disease, you don’t need right bundle branch block treatment. But if you’ve had other problems like heart disease, a heart attack or heart failure, you need to continue with treatment for those issues.

Some people with heart failure and RBBB may need a special pacemaker. It has an extra wire to help your heart’s lower chambers beat together.

When should I see my healthcare provider?

You should see your provider regularly if you have other heart problems in addition to right bundle branch block.

Call 911 or your local emergency services number if you have chest pain and think you’re having a heart attack.

What can I expect if I have RBBB?

Right bundle branch block doesn’t go away. It may stay the same without any change. Or the block may progress to involve other conduction branches. It can slowly get worse. Rarely, RBBB can lead to complete heart block.

Your outlook depends on whether you have cardiovascular disease. If you have no symptoms and no heart disease, RBBB isn’t serious. And it doesn’t change your life expectancy or add to your risk level.

But if you’ve already been diagnosed with heart failure or a heart attack, RBBB puts you at a higher risk of death.

For most people without underlying heart disease, right bundle branch block doesn’t affect daily life.