RBBB develops after pacemaker insertion

Hi -- I had a CRT-D implanted in Feb 06 to help my cardiomyopathy & LBBB. I've been doing well, no firing of the defibrillator, thank goodness! Today, my internist did an EKG as part of my annual physical. It showed a right bundle branch block, something I've never had before. Anything to worry about? My cardiologist isn't in today & I was just wondering if that had happened to anyone else after having a pacemaker.

2 Comments

RBBB

by SMITTY - 2007-09-27 04:09:09

Hi Lindalou,

I can't answer the first part of your question - to be exact, I may not be answering any of what you are asking - but the following is something I had looked us a couple of months ago for a person that was diagnosed with bundle block. I thought it may give you a little more insight into what your problem.

As for the RBBB developing after your getting a pacemaker, I know of no reason for the PM to cause that. But the heart is a strange animal with a mind of its own so anything can happen, I guess.

The heart’s natural pacemaker generates an electrical impulse which originates in the sinus node in the upper right atrium, then spreads across both atria, then travels through the AV node. Leaving the AV node, the electrical impulse penetrates into the ventricles via the His bundle. From the His bundle, the electrical impulse enters the two “bundle branches” (the right and the left). The right and left bundle branches send the electrical impulse to the right and left ventricle, respectively.

When the bundle branches are functioning normally, the right and left ventricles contract nearly simultaneously. How fast does all this happen? Consider that the average heart at rest beats 70 times a minute and that means ALL the steps described above takes a total of 0.86 seconds.

In right bundle branch block the right bundle branch no longer conducts electricity. Therefore, as the electrical impulse leaves the His bundle, it enters left bundle branch only, and is carried to the left ventricle. Then, from the left ventricle, the electrical impulse finally makes its way to the right ventricle. As a result, the two ventricles no longer receive the electrical impulse simultaneously. First the left ventricle receives the electrical impulse, then the right.

When a person is diagnosed with a bundle block (left, right, or complete heart block) and in order to keep the chambers of a heart beating simultaneously a pacemaker may be implanted. There are other factors to consider so just because a patient has some degree of bundle or heart block that does not necessarily mean they must have a pacemaker implanted. The doctor makes that decision on an individual patient basis.

Good luck,

Smitty

RBBB

by lindalouwho54 - 2007-09-27 04:09:40

I guess that would mean that I shouldn't worry too much about the RBBB, since I already have a pacemaker implanted. I'll double-check with my cardiologist when he gets back to be sure. Thank you!

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