LBBB or RBBB (Bundle Branch Block)

Lots of people come to know from their ECG that they have some defect in the Pace Maker System of the heart but they are told that since they do not have any symptoms they do not any treatment. One of them is Bundle Branch Block – it may be the Right or Left Bundle Branch. This kind of heart disease is called RBBB or LBBB.

The defect in these cases is delay or default in the Bundle of His – the nerve that transmits electrical signals to the Left or Right lower chambers of the heart or ventricles (which ultimately lead to their pumping action). This block is in the electric signals – which now reach directly through the muscles and the ventricles beat almost normally. So, the work of the heart goes on as usual. The patient does not need any treatment or have any symptoms.

The cause of the interruption is mostly a shortage of blood due to the death of the area of the heart muscles through which the nerve thread passes. This occurs because of fat deposits in the branch of the coronary arteries supplying that area. This is like a very minor heart attack – which goes unnoticed. Such patients, if they do not take care of their diet, lifestyle, and blood lipid levels, further progress to the next stage – Bi Fascicular Block (both RBBB and LBBB together) and then Complete Heart Block. The Complete Heart Block ( it is an electrical signal block) needs External Pace Maker Implantation.

Though the most common cause of Bundle Branch Blocks is coronary artery blocks/heart attacks – the other uncommon causes of LBBB or RBBB are genetic defects in the heart (from birth), Cardiomyopathy, Myocarditis, High Blood Pressure, or Pulmonary hypertension.

Ventricular Ectopics (Missing Beats)

Almost all the heartbeats that we have, generate from the S A Node or original pace Maker of the heart which is located in the wall of the Right Atrium. They first stimulate the Atria (the two upper chambers) and then the Ventricles (the lower Chambers). This leads to a normal heartbeat. But sometimes the ventricles contract on their own without any signal from above. This leads to an extra beat in the heart called Ectopic Beat or VPC (Ventricular Premature Beat). It can be felt by the patient if we count the pulse as a missing beat. Many healthy people can get it and till 3000 VPCs per day (3%) it may be considered normal. They may be because of stress, extra caffeine, extra alcohol, and strenuous exercises.

But if they become too frequent or come in doubles or triples – it can lead to giddiness or fainting. This needs treatment. There are medicines (like Amiodarone) that can control them – but the underlying cause is again Coronary Heart Disease or Shortage of blood to some part of the heart due to Coronary artery fatty deposits.

If the reasons (called Risk factors) of the fat deposits (like Cholesterol, Triglycerides, High BP, High Sugar, Smoking, stress, lack of exercise, obesity) is not withdrawn they may worse and lead to Ventricular Tachycardia or Ventricular Fibrillation. This condition now becomes very serious as the ventricles continuously generate Ectopics – which may even lead to death. Such patients immediately need Electric Shock (Cardioversion) to restore normal beats. If the preventive care is still not taken – Later on they may need to be repeated electric shocks using an ICD device.      

P -SVT or SVT (Paroxysmal Supra Ventricular Tachycardia)

This is a kind of rapid or very fast heartbeat (130-200) and occurs for a short duration. Patients feel uneasy and can feel the high speed of the heart. This is caused by the existence of some of the electrical signal generators in the atrial wall near the main pacemaker or SA Node. They sometimes become active and generate fast signals which take over the SA Node function. This is mostly called AVNRT (Atrio-Ventricular Nodal Re-entrant Tachycardia).

Since it is a temporary fast beat – it is never life-threatening. It is usually stimulated by Stress, Anxiety, caffeine, drugs, or Alcohol. It does not usually need treatment, but it occurs very frequently can be treated with drugs like Calaptin. Vagus nerve stimulation by massaging in the back of the lower part of the ear can revert it on many occasions.

The Hospital system usually wants to do RFA (Radio Frequency Ablation) in such cases which is not only invasive but often fails as they try to burn the suspected nerve areas on the wall of the Atria by trial and error method. This should be tried only if the lifestyle and medicines fail.

 EPS or EP Studies (Electro Physiological Studies)

This is an invasive testing procedure to study the origin of certain types of Arrhythmia or irregular heartbeats. This usually needs inserting a catheter in your body – which is pushed to the selected chamber of the heart. Electrodes are also pushed along the catheter to study the electrical activity of the areas of the heart to search for the origin of the abnormal nerve location. It is a complex study and very few experts can give exact opinions on the test. However, it can be done if all methods of control of the irregular beats fail. It costs usually Rs. 30000-50000.   

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