How to Prevent Bundle Branch Block
Prevention of bundle branch block (BBB) is virtually impossible when it is due to congenital, genetic, or long-standing cardiac pathology that has damaged the bundle portions of the heart’s electrical conductive system.
Some cardiac conditions are amenable to improvement and such therapy-derived improvements serve as an aid in preventing a worsening severity of BBB and the symptoms that would ensue:
- Hypertension, using antihypertensives and weight management
- Coronary artery disease, by addressing hypertension, dyslipidemia (cholesterol and triglyceride elevations), diet to mitigate metabolic syndrome, glycemic control (in diabetics), and smoking cessation
- Iatrogenic causes (via medication substitution with equally efficacious drugs that impact the conduction system less)
- Surgical and ablation changes mitigated by post-operative surveillance and care
- Conduction disturbances due to reversible electrolyte imbalance conditions that are easily corrected in diabetics or renal disease patients
From the opposite point of view, when BBB is present, patients should be evaluated for hypertension, coronary disease, myocarditis, valve disease, and other cardiomyopathy. In most patients, this can be accomplished with a careful history and physical examination. When present, prevention within the scope of bundle branch block is essentially prevention of consequences of these other sometimes life-threatening conditions.
Symptoms of LBBB and RBBB center on the idea of effectiveness of cardiac output, which is related to syncope and pre-syncope. Such patients can prevent these cognitive disruptions with an implanted pacemaker.
BBB can be incomplete or complete, and if a patient with BBB has severe cardiac output alteration (low left ventricular ejection fraction or heart failure) prevention of further cardiac deterioration and/or cardiac-related death can be accomplished with cardiac resynchronization therapy. This is a process that paces both ventricles or only the left ventricle.
The key to prevention of BBB sequelae is close observation for symptoms, evaluation of dysrhythmia with ECG, assessing functional cardiac status with echocardiography, and stepping in to override the arrhythmia when symptoms emerge or there is a concerning alteration to cardiac output.