Left Ventricular Asynchrony in Patients with Right Bundle Branch Block and Normal Ejection Fraction


Address for reprints: Berthold Stegemann, Haager Weg 97 g, 53127 Bonn, Germany. Fax: 31-433-566-516; e-mail: berthold.stegemann@medtronic.com



The role of right bundle branch block (RBBB) for the induction of left ventricular (LV) asynchrony is discussed controversially. The objective of this study was to assess presence and degree of LV asynchrony in patients with RBBB, left bundle branch block (LBBB), or left anterior hemiblock (LAH) and normal LV function.


We included 15 patients with RBBB, 13 patients with RBBB and concomitant LAH, 10 patients with pure LBBB, and 100 healthy controls into this study. All patients had normal LV function. Interventricular asynchrony was assessed as the difference of the right and LV ejection delay. Intraventricular delay was obtained by tissue synchronicity imaging-guided tissue Doppler imaging measurement.


Interventricular and left intraventricular asynchrony were linked to the presence of an LBBB. No left intraventricular asynchrony was noted during pure RBBB; interventricular delays were negative (aortic flow preceding pulmonary flow) in the presence of RBBB.


In patients with normal LV function, intraventricular asynchrony depends on the presence of an LBBB and interventricular asynchrony is inversed in the presence of RBBB.

(PACE 2013; 36:63–68)