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Treatments and drugs
By Mayo Clinic staffThere's no specific treatment for many cases of bundle branch block. Most people with bundle branch block are symptom-free and don't need treatment.
However, if you have an underlying heart condition causing bundle branch block, treatment of the underlying condition is recommended. Treatment of underlying conditions may involve using medications to reduce high blood pressure or lessen the effects of heart failure, or the use of a coronary angioplasty to open up the artery leading to your heart.
And, if you have signs or symptoms, such as fainting, your doctor may recommend an artificial pacemaker to keep your heartbeat regular.
Medication
Experts recommend treatment called reperfusion therapy for people with left bundle branch block who have had a heart attack. This treatment, given in an emergency situation, involves using medications, such as tissue plasminogen activator, to dissolve blood clots and increase the flow of blood to the heart.
Coronary angioplasty and stenting
Another option to increase blood flow to the heart is to perform coronary angioplasty. Angioplasty opens blocked coronary arteries, letting blood flow more freely to your heart. In this procedure, doctors insert a long, thin tube (catheter) that's passed through an artery, usually in your leg, to a blocked artery in your heart. This catheter is equipped with a special balloon tip. Once in position, the balloon tip is briefly inflated to open up a blocked heart artery. At the same time, a metal mesh stent may be inserted into the artery to keep it open long term, restoring blood flow to the heart. Depending on your condition, your doctor may opt to place a stent coated with a slow-releasing medication to help keep your artery open.
Artificial pacemakers
For some people with bundle branch block and a history of fainting, doctors may recommend implanting an artificial pacemaker. This pacemaker is a compact battery-operated device, which can be implanted under the skin of your upper chest (internal pacemaker).
Internal pacemakers are placed near your collarbone during surgery performed using local anesthesia. The pacemaker provides electrical pulses that keep your heart beating regularly. These devices have sensors that can detect when your heart needs a signal from the pacemaker to normalize your heart rate.
If you need a pacemaker, your doctor can explain any precautions you need to take in order to keep the device working properly and to reduce risks associated with their use.
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- Bundle branch and fascicular block. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/print/sec07/ch075/ch075i.html. Accessed Jan. 10, 2010.
- Francia P, et al. Left bundle-branch block — Pathophysiology, prognosis and clinical management. Clinical Cardiology. 2007;30:110.
- ACC/AHA 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Journal of the American College of Cardiology. 2008;51:e1.
- Goldberger AL, et al. Electrocardiography. In: Fauci AS, et al. Harrison's Principles of Internal Medicine. 17th ed. New York, N.Y.: McGraw-Hill Medical; 2008. http://www.accessmedicine.com/content.aspx?aID=2871872. Accessed Jan. 10, 2010.
- Horton CL, et al. Right bundle-branch block in acute coronary syndrome: Diagnostic and therapeutic implications for the emergency physician. The American Journal of Emergency Medicine. 2009;27:1130.
- Wong CK, et al. Prognostic differences between different types of bundle branch block during the early phase of acute myocardial infarction: Insights from the Hirulog and Early Reperfusion or Occlusion (HERO)-2 trial. European Heart Journal. 2006;27:21.
- ABC's of preventing heart disease, stroke and heart attack. American Heart Association. http://www.americanheart.org/print_presenter.jhtml?identifier=3035374. Accessed Jan. 12, 2010.
- Grogan M (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 25, 2010.
- Arnsdorf MF. Overview of left bundle branch block. http://www.uptodate.com/home/index.html. Accessed Jan. 13, 2010.
- Arnsdorf MF. Overview of right bundle branch block. http://www.uptodate.com/home/index.html. Accessed Jan. 13, 2010.
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