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Review
. 2023 Nov;34(11):2316-2329.
doi: 10.1111/jce.16050. Epub 2023 Sep 1.

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

Hussam Ali  1 , Pierpaolo Lupo  1 , Sara Foresti  1 , Guido De Ambroggi  1 , Robert H Anderson  2 , Carmine De Lucia  1 , Dario Turturiello  1 , Edoardo Maria Paganini  1 , Riccardo Bessi  1 , Igino Contrafatto  1   3 , Ahmad Abdelrady Abdelsalam Farghaly  1   4 , Ernesto Cristiano  1 , Riccardo Cappato  1
Affiliations
Review

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

Hussam Ali et al. J Cardiovasc Electrophysiol. 2023 Nov.

Abstract

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.

Keywords: catheter ablation; catheter-induced; electrophysiological study; right bundle branch block.

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References

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