Did the ECG say RBBB (Right Bundle Branch Block)? Don't worry, let's find out exactly what this is!

You may have had an ECG taken during a medical checkup, such as when you went to see a doctor for some other illness, or when you started a new job. You may have been a little worried and scared when you saw a note on that ECG report that said 'Right Bundle Branch Block', or RBBB. You may have thought, "Oh my God, is there something seriously wrong with my heart?" It's normal to think that way when you see such an unfamiliar word. But before you panic, let's understand this clearly and simply. Most of the time, this is not as serious as you think.

Simply put, what is Right Bundle Branch Block (RBBB)?

To understand this, let's first take a look at how our heart works. Imagine your heart is like a small house with four rooms. In order for the lights to turn on and the fans to run in this house, there needs to be an electrical supply, or 'current'. In the same way, our heart has its own electrical system to beat properly.

This electrical signal starts at a 'master switch' at the top of the heart. We call it the `(Sinoatrial node)` or SA node. From there, the electrical signal travels through the two upper chambers of the heart (atria) and arrives at a 'junction box' called the `(Atrioventricular node)` or AV node.

From this junction box, the electrical signal is split into two main wires that go to the two main chambers (ventricles) at the bottom of the heart. These two wires are what we call 'bundle branches'. One goes to the right chamber (right bundle branch), and the other goes to the left chamber (left bundle branch).

What should normally happen is that the electrical signal travels along both of these wires at the same speed and at the same time, causing the two lower chambers of the heart to contract (beat) together.

However, in someone with Right Bundle Branch Block (RBBB) , there is a slight blockage in the 'wire' going to the right side, or a slight decrease in the speed of the signal. It's like the 'current' is flowing a little too slowly along an old wire. Because of this, the right ventricle receives the signal a little later than the left. Because of this, the right ventricle beats a very small fraction of a second after the left ventricle beats.

There are two main types of RBBB. If the signal is very late, it is called 'Complete RBBB', and if it is only slightly late, it is called 'Incomplete RBBB'. Incomplete RBBB is usually not as serious as complete RBBB.

Who is most likely to see this condition?

This can happen to anyone. Even healthy, disease-free people can experience RBBB. However, this condition is more common as we age. Just as the wiring in an old house can become a little weaker, the heart's electrical system can also slow down a little as we age.

Research has found that by the age of 80, about 11 out of every 100 people (or 11%) will experience this RBBB condition. So you can see that it's not that rare.

What are the symptoms of RBBB?

This is the most important and comforting thing to know. For most people, there are no symptoms. You may not even know you have RBBB. It may not be discovered until an ECG is done for another reason. You will not experience any chest pain, shortness of breath, or fainting due to RBBB alone.

This means that if you have these symptoms, it may not be due to RBBB, but to another underlying medical condition. Therefore, if you have such symptoms, you should definitely see a doctor.

What are the causes of RBBB?

Although RBBB can occur in healthy people for no apparent reason, it can also be caused by certain medical conditions and other factors. Let's look at some of the main causes.

How does the doctor detect and confirm this?

RBBB is usually diagnosed with an ECG, or Electrocardiogram . This test involves attaching stickers to your chest, arms, and legs and records the electrical activity of your heart. An experienced doctor can easily tell if you have RBBB by looking at this ECG pattern.

But, the doctor doesn't stop there. There are several other, possibly more serious, conditions that show ECG patterns similar to RBBB. So the doctor will carefully examine your ECG to make sure you don't have these conditions.

Here are some such situations:

• Ventricular Tachycardia: A serious condition in which the lower chambers of the heart beat very rapidly.
• Brugada Syndrome: A genetic condition that can cause sudden cardiac arrest.
• Incomplete Left Bundle Branch Block: An incomplete blockage of the signal pathway on the left side, just like on the right side.

Therefore, even if your ECG report says RBBB, the final conclusion and advice regarding it should be given by the doctor who examines you.

Does RBBB require treatment?

There is also very good news here.

It's like a birthmark on your body. It's there, but it doesn't bother you. The doctor will probably tell you to come in once a year and have an ECG, to see if there's any change. Other than that, it doesn't require any other medication or surgery.

However, if you have RBBB due to another heart condition (such as those listed in the table of causes above), then the RBBB is not treated. The underlying condition is treated. For example, if your heart is enlarged due to high blood pressure and RBBB is caused by this condition, the treatment is to control your blood pressure. If it is caused by a heart attack, you should continue to treat it.

What is the future of someone with RBBB? Is there anything to be afraid of?

The answer to this question depends on whether or not you have other heart conditions. Let's look at those two cases separately.

1. If you have no other heart disease (Otherwise healthy)

At this point, RBBB is nothing to worry about. It doesn't shorten your life or increase your risk of having a heart attack. It's just a small 'quirk', or unique feature, in your heart's electrical system. You can go about your normal life without any problems.

2. If you have another heart condition (e.g. Heart Failure, after a Heart Attack)

In such a case, RBBB is something to consider. This does not mean that your condition has worsened because of RBBB. However, having RBBB indicates that your heart is under some strain and that its function is a little weak. Therefore, when RBBB is combined with an underlying heart condition like this, the risk of complications in the future may be slightly increased.

That is why it is extremely important for such patients to follow the treatment given by their doctor for their main heart disease without any shortcomings . They need to do things like take their medication on time, control their diet, and exercise properly.

Once RBBB is formed, it does not go away. It is a permanent condition.

What time should I see the doctor and be careful?

If you know you have RBBB, it's a good idea to stay in regular contact with your doctor.

• Regular appointments: Even if you have no other medical conditions, go for checkups at the intervals recommended by your doctor (e.g. once a year). If you have other heart conditions, be sure to attend those clinics.
• New symptoms: If you develop symptoms that you didn't have before, such as chest pain, shortness of breath, swelling in your legs, or fainting, see a doctor immediately.
• Emergency: Imagine you have unbearable chest pain, the pain radiates to your left arm, neck or jaw, you sweat profusely, and you feel difficulty breathing. These could be signs of a heart attack. In that case, don't delay. Go to the nearest hospital's Emergency Department (ETU) immediately.

Important questions to ask your doctor

If your ECG report says RBBB, asking these questions when you see your doctor can help you gain greater clarity.

• "Doctor, is there a specific reason why I have this RBBB condition?"
• "Do I need to make any changes in my daily life because of this? In things like diet, exercise, etc?"
• "How soon should I come back and check?"
• (If you have other heart conditions) "Am I at increased risk for having this RBBB with my other heart conditions? What should I do to control it?"