New onset IRBBB

New onset IRBBB

A PubMed search for new onset incomplete right bundle branch block returned 7 citations of which only two were on incomplete right bundle branch block. Another search on new onset IRBBB returned 40 citations but they were on RBBB rather than IRBBB.

The first result on IRBBB was in a study on hybrid transthoracic periventricular device closure of ventricular septal defects [1]. Three of their 59 patients developed incomplete right bundle branch block. One of them resolved during follow up. One had mild residual VSD shunt.

The second was on electrophysiological study before and after paramembranous  ventricular septal defect closure with Amplatzer device [2]. Two cases of IRBBB were noted among the 19 children whereas two had complete RBBB.

An alternate search for transient incomplete right bundle branch block gave a few more relevant results. One was on transient incomplete right bundle branch block following cryoablation of typical atrioventricular nodal reentrant tachycardia (AVNRT) in children [3].

A study on the effects of a 64.2 km ultra-trail reported incomplete right bundle branch block after the race [4]. Biomarkers of muscle damage, inflammation and oxidative stress were also evaluated in that study and found to be abnormal after the race.

Another study reported on IRBBB following coronary artery bypass surgery. Of the 913 patients, 9% had transient IRBBB while 26% had IRBBB which persisted till discharge. Corresponding percentages for complete RBBB in the study were 60% and 29% [5].

It is common knowledge that IRBBB pattern can occur with right ventricular dilatation in acute pulmonary embolism.

References

1. Wu L, Tanidir IC, Ye D, Zhang X, Li B, Zhu D, Deng G, Chen H. Hybrid Transthoracic Periventricular Device Closure of Ventricular Septal Defects: Single- Center Experience. Braz J Cardiovasc Surg. 2021 Feb 1;36(1):48-56. doi: 10.21470/1678-9741-2020-0115. PMID: 33118345; PMCID: PMC7918382.
2. Kramoh EK, Dahdah N, Fournier A, Sanatani S, Hosking M, Miró J. Invasive measurements of atrioventricular conduction parameters prior to and following ventricular septal defect closure with the amplatzer device. J Invasive Cardiol. 2008 May;20(5):212-6. PMID: 18460702.
3. Kafalı HC, Özgür S, Şahin GT, Akay EÖ, Güzeltaş A, Ergül Y. Cryoablation with an 8-mm tip catheter for typical AVNRT in children: a single center 5-year experience. J Interv Card Electrophysiol. 2021 Oct;62(1):113-122. doi: 10.1007/s10840-020-00868-x. Epub 2020 Sep 23. PMID: 32968865.
4. Le Goff C, Kaux JF, Dulgheru R, Seidel L, Pincemail J, Cavalier E, Melon P. The impact of an ultra-trail on the dynamic of cardiac, inflammatory, renal and oxidative stress biological markers correlated with electrocardiogram and echocardiogram. Acta Cardiol. 2021 Sep;76(7):739-747. doi: 10.1080/00015385.2020.1778871. Epub 2020 Jun 15. PMID: 32539581.
5. Chu A, Califf RM, Pryor DB, McKinnis RA, Harrell FE Jr, Lee KL, Curtis SE, Oldham HN Jr, Wagner GS. Prognostic effect of bundle branch block related to coronary artery bypass grafting. Am J Cardiol. 1987 Apr 1;59(8):798-803. doi: 10.1016/0002-9149(87)91094-0. PMID: 3493679.