Brief Answer: please see details. Detailed Answer: Dear Sir Right bundle branch block with no underlying structural heart disease and no symptoms is considered to be benign as yet. A number of epidemiological studies have been done to look at the future outcomes of such individuals and most of them found "no increased risk in subjects with RBBB and no symptoms/ underlying heart condition". However in one of the recent papers published from Europe, it was shown that future risk of heart attack and death was more in subjects with RBBB. This is in contradiction to most previous studies. There are also some questions about the findings of study which were not explainable. However the authors concluded and agreed with the current notion that we can not do anything for this except for better management of traditional risk factors in such individuals. These include good management of diabetes, high blood pressure, cessation of smoking, weight control, control of cholesterol, regular exercise and avoiding stress. Hope this elaborates the current medical thinking on the issue. Feel free to discuss if there is anything else. sincerely Sukhvinder

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Brief Answer: please see details Detailed Answer: Dear Sir 1. Hazard ratio is simply the risk of occurrence of an event in those with a defined risk factor as compared to the occurrence in those without that risk factor. For example if an event took place in 10 persons out of 100, who were non-smokers in 5 years and hazard ratio for smoking is 1.6, then the same event will occur in 16 persons out of 100, who will smoke, in next 5 years. This is usually assumed to be independent of other risk factors (multivariate analysis). 2. Yes, one of the catch points of Copenhagen study is that a large proportion of patients in study acquired RBBB through the period of study. Definitely, by logic, those who acquired in later years, had more likelihood of acquired diseases as compared to those where it was purely congenital and not associated with any underlying heart condition. Because those who acquired it over a period of time, may have some associated cause like COPD, ischemia, older age or quicker degeneration of conduction system. Yes, as per Copenhagen study, the risk exists even after adjusting for other major cardiovascular risk factors. 3. Yes we do see patients who have RBBB for years and they continue to live without serious health issues. 4. In conclusion, Current literature and logic says, that those with RBBB which is likely to be congenital and do not have symptoms or structural heart disease, will continue to have no or minimal effect on their health due to this RBBB. Whatever little Bad effect they may have , can not be prevented, by means available at present, as per current knowledge. They however should adopt healthy life style and preventive life style , to prevent future cardiovascular event. Hope this provides more insight. If I am not clear at any point please feel free to discuss. Sincerely Sukhvinder

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Brief Answer: see details Detailed Answer: Dear Sir 1. This is an epidemiological study which truly do no address congenital RBBB. It included new onset RBBB and also mentioned risk factors for same like male sex , old age, high BP etc. which may confer risk on their own. 2. There are some queries about its findings mentioned in the journal itself but are not relevant to the current discussion. The patients were not subjected to ECHO to find out structural heart disease. 3. This study has not been contradicted by any fresh study as per my information.Only study which can contradict or answer the relevant question is which takes up true RBBB with no structural heart disease on ECHO and has healthy subjects. Sincerely Sukhvinder

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