Bundle Branch Block
Bundle branch block (BBB) is a disruption in the normal flow of electrical pulses that drive the heart beat.
Bundle branch block belongs to a group of heart problems called intraventricular conduction defects (IVCD). There are two bundle branches, right and left. The right bundle carries nerve impulses that cause contraction of the right ventricle (the lower chamber of the heart) and the left bundle carries nerve impulses that cause contraction of the left ventricle. The two bundles initially are together at a junction called the bundle of His. Nerve impulses come through the sinus node of the heart to the bundle of His and then move into the right and left bundle branches. Bundle branch block is a slowing or interruption of nerve impulses. A problem may exist in any of the three bundles.
Patients with BBB are generally without symptoms unless the disease is severe enough to cause a complete infranodal A-V block and very slow heart rate. In patients with right bundle branch block (RBBB), the nerve impulse is conducted slowly or not at all. The right ventricle finally receives the impulse through muscle-to-muscle spread, outside the regular nerve pathway. This mechanism of impulse transmission is slow and results in a delayed contraction of the right ventricle. There are several types of left bundle branch block (LBBB), each producing its own characteristic mechanism of failure. In each case, the nerve impulse is blocked or delayed. Patients with LBBB may have left ventricular disease or cardiomyopathy.
Causes and symptoms
Left bundle branch block usually happens as a consequence of other diseases such as arteriosclerosis, rheumatic fever, congenital heart disease, myocarditis, myocardial infarction, metastatic heart tumors, or other invasions of the heart tissue. Right bundle branch block happens less often from underlying heart disease.
Detection of BBB usually takes place during a normal physical examination. The block shows up as a widening of the second heart sound. Confirmation of BBB is obtained by electrocardiogram (ECG). The pattern seen in the electrocardiogram indicates pulses in a heart beat and their duration. A QRS duration of greater than 110 milliseconds is a diagnostic indication of BBB. There is a unique ECG pattern for blocks in each of the three bundles.
There is no specific therapy for BBB. Patients are usually treated for associated heart diseases.
The prognosis of blockage in any of the three bundle branches depends on the prognosis of the associated heart disease. The associated diseases determine the outcome of the patient's health. Occasionally, disruptions in bundle branches lead to complete infranodal A-V block, a more serious blockage of nerve impulses. Approximately 2% of patients with BBB develop infranodal A-V blockage and these patients often require artificial pacemakers.
Alexander, R. W., R. C. Schlant, and V. Fuster, eds. The Heart. 9th ed. New York: McGraw-Hill, 1998.
Berkow, Robert, ed. Merck Manual of Medical Information. Whitehouse Station, NJ: Merck Research Laboratories, 1997.
John T. Lohr, PhD
Electrocardiogram—The pattern of the heart's electrical impulses that indicate the order and condition of the heart's components.
QRS—A pattern seen in an electrocardiogram that indicates the pulses in a heart beat and their duration. Variations from a normal QRS pattern indicate heart disease.