Abstract
The pertinent literature on intermittent complete bundle branch block is critically reviewed. It is pointed out that the majority of cases reported are of intermittent left bundle branch block. Four cases of intermittent complete right bundle branch block without apparent heart disease are reported. Critical heart rate appeared to be the dominant feature determining whether complete bundle branch block was present or not. Vectorcardiograms during normal conduction and complete right bundle branch block demonstrated conclusively that the changes in conduction were confined to the terminal QRS interval in contradistinction to the excitation in left bundle branch block. The low incidence of intermittent complete right bundle branch block is apparent in that only the four reported cases were found in an electrocardiographic survey of approximately 70,000 asymptomatic subjects. For comparison two cases of intermittent left bundle branch block in the presence of heart disease are included. It is suggested that intermittent right bundle branch block may not have the same significance as intermittent left bundle branch block. Studies on intermittent right bundle branch block reveal fundamental information on the excitation process in complete right bundle branch block.
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