Bundle Branch Block: Management & Treatment Menu

Management of Bundle Branch Block

Right Bundle Branch Block (RBBB)

The structural heart diseases associated with RBBB are:

  • Cor pulmonale
  • Pulmonary embolism
  • Myocardial ischemia/infarction
  • Myocarditis
  • Hypertension
  • Congenital heart disease

Outcomes depend on comorbidities (underlying heart disease), and those with RBBB without heart disease have excellent long-term outcomes.

If there are no symptoms and there is no underlying heart disease, treatment is limited to just serial observation (close surveillance for ECG follow-up and for symptoms that may occur).

If there are symptoms in the pre-syncope to syncope range, treatment is with an implanted cardiac pacemaker if no reversible causes are identified, e.g., electrolyte disturbances, medications, etc.

Left Bundle Branch Block (LBBB)

If a patient with LBBB is asymptomatic and has no underlying heart disease, no therapy is indicated other than close surveillance with serial ECGs and for the emergence of symptoms.

If a patient is symptomatic (pre-syncope, syncope, and other cognitive changes) and if there are no reversible causes (electrolyte disturbances, medications, etc.), a permanent pacemaker is indicated to treat any symptomatic conduction system disturbances.

Heart Failure

Decreases in left ventricular fraction cardiac output may require a selective pace making protocol that involves using cardiac resynchronization therapy. Such pacemakers selectively pace the ventricles or only the left ventricle to reestablish a normal cardiac output.


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This information is provided by Vascular Health Clinics and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition.

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