Overview of Right Bundle Branch Block

Right bundle branch block is an abnormal pattern that is seen on the electrocardiogram (ECG), which indicates that the heart’s electrical impulse is not being distributed normally across the ventricles. Specifically, right bundle branch block means that the electrical stimulation of the right ventricle is being delayed.

Causes of Right Bundle Branch Block
Verywell / Gary Ferster

Causes

The two bundle branches (right and left) are the electrical pathways that allow the cardiac electrical impulse to spread rapidly and evenly through both ventricles so that the beating of the heart is well-coordinated.

With right bundle branch block, there is a partial or complete blockage of the electrical impulse to the right ventricle. Right bundle branch block delays the electrical activation of the right ventricle. Subsequently, the right ventricle is stimulated after the left ventricle is stimulated, and its contraction is delayed.

Similar to left bundle branch block (in which the stimulation of the left ventricle is delayed), right bundle branch block affects how efficient the heart can pump blood. Because the right side of the heart moves blood to the lungs instead of the entire body, RBBB carries a lower risk of death than LBBB.

Right bundle branch block is sometimes associated with an underlying cardiac or pulmonary condition. When right bundle branch block is diagnosed, a medical evaluation is usually required - particularly to uncover and reduce cardiovascular risks.

Diagnosis

Right bundle branch block causes a characteristic change on the ECG, so doctors can usually readily diagnose this condition simply by examining the electrocardiogram.

In bundle branch block, the QRS complex—the portion of the ECG that represents the electrical impulse traveling across the ventricles—is wider than normal, since it takes longer than normal for the impulse to be distributed. In right bundle branch block, there is a characteristic pattern this widening takes across the 12 leads (or “views”) provided by a standard ECG. So, simply by taking note of the pattern of widening of the QRS complex, it is usually easy to determine the presence of right bundle branch block.

Sometimes, right bundle branch block is part of Brugada syndrome. If the ECG in a young person shows a pattern suggestive of right bundle branch block, accompanied by elevation in the ST-segments in leads V1 and V2 — especially if there also is a history of unexplained episodes of syncope or lightheadedness — Brugada syndrome should be considered as a possibility.

Significance

The incidence of right bundle branch block increases with age. It occurs twice as often in people over age 65 as compared to those over age 40 and is more common in men.

Right bundle branch block is more common than left bundle branch block and may be less serious. However, right bundle branch block does indicate a higher risk for heart disease and eventually needing a pacemaker.

When right bundle branch block is detected, it can be classified as either a complete block or an incomplete block based on ECG findings. An incomplete block means that electrical signals are being conducted better than in a complete block.

Because an incomplete block can sometimes progress to a complete block, ongoing monitoring is recommended. However, an incomplete block generally does not pose a risk to health by itself.

Underlying Heart and Lung Disease

The right bundle branch, as it courses within the muscle of the right ventricle, is relatively superficial to the surface of the ventricular cavity. This makes the right bundle branch susceptible to damage and stretching whenever the right ventricle is placed under stress of any kind.

So, right bundle branch block will often occur with 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.

Furthermore, right bundle branch block may also be seen with any lung condition that causes a chronic elevation in the pressures within the right ventricle, especially pulmonary hypertension. Pulmonary hypertension, in turn, can be caused by an array of various lung disorders, including chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea.

To note, right bundle branch block is common with any condition that acutely raises pressures in the right ventricle. The most common condition that does this is a pulmonary embolus.

Anyone who is discovered to have right bundle branch block needs a medical evaluation that concentrates on signs of heart or lung disease. A chest X-ray and an echocardiogram are commonly-used screening tools for this purpose.

Because the right bundle branch is susceptible to anything that can produce even small trauma in the right ventricle, transient right bundle branch block occurs occasionally in patients undergoing cardiac catheterization. This temporary right bundle branch block occurs when the catheter irritates the right bundle branch. This transient bundle branch block usually resolves quickly (within minutes) once the catheter is removed.

However, in people who already have left bundle branch block, causing even this transient right bundle branch block will likely create temporary complete heart block, and the heart can stop beating. So, in people with left bundle branch block who are having a right-sided cardiac catheterization, sometimes a temporary pacemaker is inserted during the procedure, to assure that the heart rhythm will continue uninterrupted during the study.

The Efficiency of the Heartbeat

With either right or left bundle branch block, 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 heartbeat.

However, the reduction in the heart's efficiency is probably less important in right bundle branch block. So, for instance, the use of cardiac resynchronization therapy (CRT) may not be as helpful in people with right bundle branch block, even if they have heart failure.

Indications for a Pacemaker

Right bundle branch block, by itself, does not require treatment with a permanent pacemaker. However, in some people, right bundle branch block does not occur by itself but instead represents one manifestation of a more general problem with the heart’s electrical conduction system. In such cases, a pacemaker may eventually be required if sick sinus syndrome or heart block should develop.

A Word From Verywell

Right bundle branch block, even in people without any heart problems, indicates increased cardiovascular risk. Anyone who is found to have it should have a screening evaluation to rule out underlying heart or lung disease, and minimize the cardiovascular risk factors they can control. Right bundle branch block is especially serious in people who already have heart failure or have had a heart attack.

Arrhythmias Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Old Man
Was this page helpful?
Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. About the heart and blood vessels - health encyclopedia - university of rochester medical center.

  2. Rasmussen PV, Skov MW, Ghouse J, et al. Clinical implications of electrocardiographic bundle branch block in primary care. Heart. 2019;105(15):1160-1167.

  3. Surawicz B, Childers R, Deal BJ, et al. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part III: intraventricular conduction disturbances: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology. J Am Coll Cardiol 2009; 53:976. DOI:10.1016/j.jacc.2008.12.013

  4. Francis J, Antzelevitch C. Brugada syndrome. International Journal of Cardiology. 2005;101(2):173-178.

  5. Jeong JH, Kim JH, Park YH, et al. Incidence of and risk factors for bundle branch block in adults older than 40 years. Korean J Intern Med. 2004;19(3):171-178.

  6. Alventosa-Zaidin M, Guix Font L, Benitez Camps M, et al. Right bundle branch block: Prevalence, incidence, and cardiovascular morbidity and mortality in the general population. European Journal of General Practice. 2019;25(3):109-115.

  7. Kusumoto FM, Schoenfeld MH, Barrett C, et al. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: executive summary. Journal of the American College of Cardiology. 2019;74(7):932-987.

  8. Henin M, Ragy H, Mannion J, David S, Refila B, Boles U. Indications of cardiac resynchronization in non-left bundle branch block: clinical review of available evidence. Cardiol Res. 2020;11(1):1-8.

Additional Reading
  • 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.

  • Bussink BE, Holst AG, Jespersen L, et al. Right bundle Branch Block: Prevalence, Risk factors, and Outcome in the General Population: Results From the Copenhagen City Heart Study. Eur Heart J 2013; 34:138.

  • Badheka AO, Singh V, Patel NJ, et al. QRS Duration on Electrocardiography and Cardiovascular Mortality (from the National Health and Nutrition Examination Survey-III). Am J Cardiol 2013; 112:671.
  • Zhang ZM, Rautaharju PM, Soliman EZ, et al. Mortality Risk Associated With Bundle Branch Blocks and Related Repolarization Abnormalities (From the Women's Health Initiative WHI). Am J Cardiol 2012; 110:1489.