General responses to selected questions from Joel Braunstein, MD, of Johns Hopkins University and Joseph Toscano, MD.
Question:
I have recently been diagnosed with a "right branch irregularity." All I can find out is that it is related to the electric impulse function of the heart. What is it and where can I get more details about it?
Answer:
I don't know exactly what you mean by "right branch irregularity," but based on your description of it being related to electrical impulse function of the heart, I think you might be referring to "right bundle branch block." If this is the case, the following pertains: In the course of each heartbeat, the electrical impulse which causes the heart muscle to contract travels along specialized nerve tissue within the heart. Between the upper and lower chambers of the heart, the impulse at one point travels in two bundles of nerve tissue called the right bundle branch and the left bundle branch. Each of these goes to different areas of the lower chambers of the heart. If there is a slowing of the electrical activity along one of these branches, it is referred to as a bundle branch block. The block may be complete or incomplete (partial), based on the EKG pattern. There is no specific treatment required for right bundle branch block (RBBB), although if someone has a severe form of combined block of both the left and right bundles (or, more commonly, a block at a point higher up where the bundles travel together), he or she might need a pacemaker.
In terms of causes, many of those with RBBB have an inherited form that is not associated with significant cardiac or other health problems. Congenital heart disease (usually evident in infancy or childhood), a prior heart attack involving typically the right and lower portions of the heart, sleep apnea, emphysema and other lung diseases are also associated with RBBB.
In terms of risk for further cardiac problems, that depends on other factors. In general, left bundle branch block is associated with more problems than RBBB. As mentioned above, many of those with RBBB have an acquired form that is associated with no other health problems. On the other hand, if RBBB develops as someone is having a heart attack, it predicts a more complicated course than for those who don't develop RBBB. As well, in some older patients who have already had other cardiac problems, complete RBBB is associated with an increased risk of death from all causes.
