Right bundle branch block medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]; Raviteja Guddeti, M.B.B.S. [3]

In general treatment for right bundle branch block is not necessary. These patients need not limit their activity. However, if the RBBB progresses to heart block, the patient may be at risk for adverse clinical outcomes. In these patients further electrophysiologic testing may be necessary. Those patients who develop right bundle branch block after surgery should undergo EKG testing each year to evaluate for interval changes. In particular, care should be taken to observe for the development of sinus bradycardia supraventricular or ventricular ectopy.

• Patients with asymptomatic right bundle branch block do not require any treatment. However, if the right bundle branch block is accompanied by second degree or third degree heart block along with symptoms like syncope, implantation of a pacemaker is necessary.
• There is insufficient evidence to prove that cardiac resynchronization therapy is effective as a management plan for right bundle branch block, as opposed to the left bundle branch block.
• Right heart catheterization in patients with already existing left bundle branch block, can lead to development of complete heart block as a complication if RBBB develops. Hence catheter insertion of right heart in those with LBBB should be done with preparation for immediate transcutaneous pacing.

Right bundle branch blcok is considered an absolute contraindication to the use of the following medications:

• Flecainide

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