Mortality in patients with right bundle-branch block in the absence of cardiovascular disease

Prakriti Gaba, Dawn Pedrotty, Christopher V. Desimone, Amanda R. Bonikowske, Thomas G. Allison, Suraj Kapa

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


BACKGROUND: Right bundle-branch block (RBBB) occurs in 0.2% to 1.3% of people and is considered a benign finding. However, some studies have suggested increased risk of cardiovascular morbidity and mortality. We sought to evaluate risk attributable to incidental RBBB in patients without prior diagnosis of cardiovascular disease (CVD). METHODS AND RESULTS: We reviewed the Mayo Clinic Integrated Stress Center database for exercise stress tests performed from 1993 to 2010. Patients with no known CVD—defined as absence of coronary disease, structural heart disease, heart failure, or cerebrovascular disease—were selected. Only Minnesota residents were included, all of whom had full mortality and outcomes data. There were 22 806 patients without CVD identified; 220 of whom (0.96%) had RBBB, followed for 6 to 23 years (mean 12.4±5.1). There were 8256 women (36.2%), mean age was 52±11 years; and 1837 deaths (8.05%), includ-ing 645 cardiovascular-related deaths (2.83%), occurred over follow-up. RBBB was predictive of all-cause (hazard ratio [HR], 1.5; 95% CI, 1.1–2.0; P=0.0058) and cardiovascular-related mortality (HR,1.7; 95% CI, 1.1–2.8; P=0.0178) after adjusting for age, sex, diabetes mellitus, hypertension, obesity, current and past history of smoking, and use of a heart rate-lowering drug. Patients with RBBB exhibited more hypertension (34.1% versus 23.7%, P<0.0003), decreased functional aerobic capacity (82±25% versus 90±24%; P<0.0001), slower heart rate recovery (13.5±11.5 versus 17.1±9.4 bpm; P<0.0001), and more dysp-nea (28.2% versus 22.4%; P<0.0399) on exercise testing. CONCLUSIONS: Patients with RBBB without CVD have increased risk of all-cause mortality, cardiovascular-related mortality, and lower exercise tolerance. These data suggest RBBB may be a marker of early CVD and merit further prospective evaluation.

Original languageEnglish (US)
Article numbere017430
JournalJournal of the American Heart Association
Issue number19
StatePublished - 2020


  • ECG
  • Mortality
  • Right bundle-branch block
  • Stress testing

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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