Brief Answer: please see details Detailed Answer: Dear Sir As per Copenhagen study, Hazard ratio for all cause mortality (death) is 1.31 and for heart attacks 1.37 in men. The hazard ratio for pacemaker insertion was 2.17. 1. For 100 subjects with RBBB the death rate will be 1.31 times as for those without RBBB. Now the actual number depends upon the death rate in those without RBBB. For example if 10 deaths occur in 10 years in 100 subjects without RBBB, then 13 deaths will take place in 10 years in those 100 with RBBB. 2. The hazard ratio for heart attack in men was not statistically significant. That means this could have been a chance occurrence rather than true effect of RBBB. Surprisingly, the Hazard ratio for heart attack was significant in ladies. This could not be explained by the authors of study. 3. The chances of pacemaker insertion was 2.17 times more in those with RBBB. But in absolute terms only 12 subjects got a pacemaker inserted over a period of ~21 years among the 166 subjects (with RBBB). This number would be 5.5 for similar number of controls without RBBB. hence over a period 21 years only 6-7 persons out of 166 will get additional pacemaker insertion. Hope this clarifies the issue. Feel free to discuss further. Sincerely Sukhvinder

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Brief Answer: please see details Detailed Answer: Dear Sir This ECG shows normal sinus rhythm at a rate of ~90 bpm, PR interval of ~ 160 ms, Complete RBBB with QRSD of ~ 130 ms. If the subject has no symptoms and complaints, his clinical examination is normal and his x-ray chest is also normal, I would not do any further work up. However if there is anything positive out of these three, I would order a cardiac ultrasound (Echocardiogram). If cardiac ultrasound is normal and there is no symptoms suggestive of complete heart block (syncope or pre-syncope), I would not investigate further. A history of syncope, would further warrant opinion of an elctrophysiologist and may be electrophysiological study. I explained all the possible scenarios. Hope this helps. Sincerely Sukhvinder

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Brief Answer: please see details Detailed Answer: Dear Sir 1. The duration of QRS is ~130ms. It is more than 3 small squares to me, hence >120 ms. 2. It is likely to be a normal variant (benign) in the absence of symptoms and normal ECHO. If it is a part of degenerative (aging) disease of your conduction system, is something which none can answer with surety. Only logical inferences can be drawn, like, if it same for 5 years, then it is likely to be very slow process. The need for pacemaker in this process may arise after many years (or may not arise at all). How many years in your case? None knows. The indication for pacemaker will be development of symptoms and further progression to AV block or complete heart block. Isolated RBBB can not be an indication for pacemaker (whatsoever the QRS duration may be), especially so in absence of symptoms. 3. If you are already doing certain level of exercise without symptoms you can continue to do so even now. Sincerely Sukhvinder

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Brief Answer: please see details Detailed Answer: Dear Sir 1. You must not be worried, Because even if , even if we imagine that there are some increased chances of pacemaker insertion/ death, it is not known that you will be among the ones who will have increased risk or normal risk (out of subjects with RBBB ). Second till now it is not clearly known that the minimally increased risk is definitely there or not; it is still controversial. Third, If it is there, we can not change anything about it as yet. 2. A number of studies prior to Copenhagen study mentions that complete RBBB with normal heart and no symptoms, is benign. You can have the exact references from the editorial regarding Copenhagen study itself. Please refer to following links. WWW.WWWW.WW 3. Please continue your exercise and healthy heart practices as I mentioned in my previous discussion. sincerely Sukhvinder

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