Abnormal heartbeat

By George N. True II

I recently had an ECG test because I have palpitations and hypertension at times. The doctor said I have IRBBB. What is this? Is this a serious disease? Can it be cured? – Ederlyn Baltan

Electrical impulses normally travel to the left or right side of the bottom chambers or ventricles of the heart to make it beat. These move along a pathway that includes two branches called the left and right bundles.

When there’s a problem along the way – for instance, the electrical impulses are either delayed or blocked because one or both bundles are damaged due to a heart attack – the condition is known as a bundle branch block (BBB). This causes the heart beat abnormally since it is harder to pump blood through your body. If the right side is affected, this is known as right bundle branch block (RBBB).

Doctors once thought that a block in the peripheral right His-Purkinjie system (that relays electrical impulses and helps ensure the proper beating of the heart) was responsible for what’s known as incomplete RBBB or IRBBB. This was associated with acquired or congenital (present at birth) lesions in the said system.

No known cause

But a study published in Circulation, one of the journals of the American Heart Association, said researchers have found other instances of IRBBB without the telltale cardiovascular lesions. This has led other researchers to question the true nature of this condition.

In some, RBBB has no known cause, but the Mayo Clinic said this can be due to:

Blood clot in the lungs (pulmonary embolism)

Heart attack (myocardial infarction)

Congenital heart defects

Hypertension in the pulmonary arteries (pulmonary hypertension)

Bacterial or viral infection of the heart muscle (myocarditis)

Who are most likely to suffer from BBB? These include the elderly and people with high blood pressure or heart disease. Depending on what’s causing your condition, a diagnosis of RBBB might not require any treatment. But if there is an underlying health problem, the doctor will look into this and do what’s necessary to make the heart beat normally again.

No symptoms

Most patients have no symptoms and are unaware that they have a problem. In rare cases, there is fainting (syncope) or the feeling that you’re about to faint (presyncope). When this occurs, see a doctor immediately to rule out other serious problems. Since you suffer from hypertension at times, you should monitor your blood pressure and have regular checkups to determine what’s causing this.

The good news is that many people with IRBBB have no serious health problem and this commonly occurs in healthy young athletes, according to the Texas Heart Institute. It added that the condition can be found in 15% of the general population and is not harmful in most cases.  .

Dr. M. Irene Ferrer, consultant in cardiology Metropolitan Life Insurance Company, and Columbia University consultant electrocardiographer, said many normal people have IRBBB with no history of heart disease or other symptoms.

Other options

If you have a heart condition that’s causing BBB, treatment might involve medications to reduce high blood pressure or reduce symptoms of heart failure. For those with BBB who faint, the doctor might recommend a pacemaker. This is a small device implanted under the skin of the upper chest. It has two wires connected to the right side of your heart that release electrical impulses to make the heart beat normally.

Another option is cardiac resynchronization therapy (biventricular pacing). This is like having a pacemaker, but a third wire is connected to the left side of the heart so the two lower chambers of the heart contract together.

For questions, email georgenavatrue@yahoo.com.