The Prevalence, Morphological Patterns, and Clinical Correlations of Complete Right Bundle Branch Block in Pediatric Patients: A Single-Center Retrospective Study
Abstract
Objective: Complete right bundle branch block (CRBBB) is one of the most common intraventricular conduction disorders encountered in electrocardiogram (ECG) examinations of children. Information on how frequently CRBBB is seen in pediatric patients, what morphological patterns it exhibits, and its clinical significance is quite limited. This study aims to reveal the frequency, types, and correlation with echocardiography (ECHO) findings of CRBBB in children without a history of cardiac surgery.
Method: A total of 45,160 pediatric ECGs recorded at a single center between December 2017, and July 2025 were retrospectively reviewed. Fifty-one cases aged 0-18 whose ECGs met the diagnostic criteria for CRBBB were included in the study. Patients with a history of cardiac surgery, myocarditis or acute rheumatic fever, a known diagnosis of congenital heart disease, and repeated ECG recordings were excluded. The demographic data, ECG measurements, ECHO results, and, if available, Holter and exercise test findings of all patients were evaluated.
Results: CRBBB was detected in a total of 51 cases (0.113%); 86.3% of them were male. The highest number of cases were in the 4-16 age group (62.7%). The morphological distribution was as follows: Type 3 (39.2%), Type 2 (29.4%), Type 1 (17.6%), and Type 4 (13.7%). ECHO examinations revealed normal findings in 76.5% of the cases, while 23.5% had structural anomalies. The most common pathologies were large secundum ASD (5.9%) and mitral valve anomalies (13.7%). Holter and exercise test results were largely normal. There was no significant difference in basic ECG parameters between the different RBBB types (p>0.05).
Conclusion: Although CRBBB is rare in children, approximately one-quarter of the cases are associated with structural heart disease. Its higher frequency in males and the 4-16 age group, the prominence of the Type 3 pattern, and the presence of right ventricular dilation in cases with ASD suggest that this finding should not be overlooked. Although CRBBB follows a benign course in most children, echocardiographic evaluation is recommended in the presence of a wide QRS duration, additional ECG abnormalities, or clinical suspicion.
Keywords
Complete right bundle branch block, child, prevalence, morphological pattern, echocardiography, atrial septal defect
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