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Catheter-induced right bundle branch block: Practical implications for the cardiac electrophysiologist

Lookup NU author(s): Professor Bob Anderson

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Abstract

© 2023 Wiley Periodicals LLC. The right bundle branch (RBB), due to its endocardial course, is susceptible to traumatic block caused by “bumping” during right-heart catheterization. In the era of cardiac electrophysiology, catheter-induced RBB block (CI-RBBB) has become a common phenomenon observed during electrophysiological studies and catheter ablation procedures. While typically transient, it may persist for the entire procedure time. Compared to pre-existing RBBB, the transient nature of CI-RBBB allows for comparative analysis relative to the baseline rhythm. Furthermore, unlike functional RBBB, it occurs at similar heart rates, making the comparison of conduction intervals more reliable. While CI-RBBB can provide valuable diagnostic information in various conditions, it is often overlooked by cardiac electrophysiologists. Though it is usually a benign and self-limiting conduction defect, it may occasionally lead to diagnostic difficulties, pitfalls, or undesired consequences. Avoidance of CI-RBBB is advised in the presence of baseline complete left bundle branch block and when approaching arrhythmic substrates linked to the right His-Purkinje-System, such as fasciculo-ventricular pathways, bundle branch reentry, and right-Purkinje focal ventricular arrhythmias. This article aims to provide a comprehensive practical review of the electrophysiological phenomena related to CI-RBBB and its impact on the intrinsic conduction system and various arrhythmic substrates.

Publication metadata

Author(s): Ali H, Lupo P, Foresti S, De Ambroggi G, Anderson RH, De Lucia C, Turturiello D, Paganini EM, Bessi R, Contrafatto I, Farghaly AAA, Cristiano E, Cappato R

Publication type: Article

Publication status: Published

Journal: Journal of Cardiovascular Electrophysiology

Year: 2023

Volume: 34

Issue: 11

Pages: 2316-2329

Print publication date: 01/11/2023

Online publication date: 01/09/2023

Acceptance date: 21/08/2023

ISSN (print): 1045-3873

ISSN (electronic): 1540-8167

Publisher: Wiley-Blackwell Publishing, Inc.

URL: https://doi.org/10.1111/jce.16050

DOI: 10.1111/jce.16050

PubMed id: 37655997

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