Right bundle branch block in complete transposition

Two of 26 infants with complete transposition presented with complete right bundle branch block in the first year of life, and 10 showed incomplete right bundle branch block. In no instance was the right ventricular conduction anomaly related to surgery or cardiac catheterization and it was not present at birth. The two cases with complete right bundle branch block had prolonged and severe hypoxemia and markedly dilated right ventricles. One had depressed right ventricular function and died after a Mustard procedure from low output syndrome. Whereas incomplete right bundle branch block may reflect right ventricular hypertrophy, it is suggested that complete right bundle branch block in complete transposition may signify right ventricular dysfunction and possibly irreversible changes of the right ventricular myocardium. It may be a sequel of long-term hypoxemia and pressure overload. Once observed, it is perhaps an indication for an alternative surgical approach other than an intra-atrial repair procedure.