Bundle branch block in patients with chronic coronary artery disease: Angiographic correlates and prognostic significance

Abstract

The onset of bundle branch block during acute myocardial infarction is indicative of ischemia in the distribution of the left anterior descending coronary artery. However, whether patients with chronic coronary artery disease and bundle branch block have a predominance of left anterior descending artery lesions is not known. Similarly, the prognostic implications of bundle branch block have been studied primarily in the setting of acute myocardial infarction, and the independent prognostic implications of bundle branch block in patients with chronic coronary artery disease are not known. The electrocardiograms (ECGs) of 15,609 patients with chronic coronary artery disease who underwent coronary and left ventricular angiography as part of the Coronary Artery Surgery Study (CASS) were reviewed, and 522 patients with bundle branch block were identified. Patients with bundle branch block had both more extensive coronary artery disease and worse left ventricular function than did patients without bundle branch block. However, no particular location of coronary artery stenosis or left ventricular wall motion abnormality predominated in patients with bundle branch block. During a follow-up period of 4.9 +/- 1.3 years, 2,386 patients died. Actuarial probability of mortality at 2 years in patients with left bundle branch block was more than five times that in patients without bundle branch block (p less than 0.0001), and in patients with right bundle branch block the mortality rate was approximately twice that in patients without bundle branch block (p less than 0.0001). Stepwise Cox regression analysis showed that left bundle branch block, but not right bundle branch block, was a strong predictor of mortality, independent of degree of heart failure, extent of coronary disease and other variables (p less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Bundle-Branch Block in a General Male Population

“…15 Several studies have found increased mortality in patients with bundle-branch block and concomitant cardiovascular disease. 1,3,8,16 In patients with acute myocardial infarction, the presence of bundle-branch block is a marker of worse outcome 17,18 that persists in the modern era of thrombolytic therapy. 19 Among patients with chronic coronary artery disease, bundle-branch block has been shown to be a strong predictor of mortality, independent of the degree of heart failure and extent of coronary disease.…”

Left bundle‐branch block—pathophysiology, prognosis, and clinical management

“…In several studies on chronic and acute CAD, LBBB was found to be an excellent predictor of mortality and events [20][21][22][23][24] (Table 2). In 681 patients with acute myocardial infarction (AMI) enrolled in the Thrombolysis and Angioplasty in Myocardial Infarction (TAMI) 9 and Global Utilization of Streptokinase and t-PA for Occluded Arteries (GUSTO) 1 protocols, 25 the incidence of LBBB was found to be 7%.…”

“…In the setting of LBBB and apparent structural heart diseases, the available observational studies suggest caution and often concern in the prognostic evaluation. [8][9][10] On the other hand, new onset LBBB in asymptomatic subjects raises several questions concerning the diagnostic algorithm and the clinical behaviour, with particular regard to the need for further investigation, intensity and nature of follow-up, and indications for specialist referral.…”

Noninvasive risk stratification after myocardial infarction: Rationale, current evidence and the need for definitive trials

“…However, a QRS duration of 120 ms or longer, the most commonly applied cutpoint, has no to only modest independent predictive value in identifying patients at risk of a cardiac arrest (38,39). Moreover, a longer QRS duration was not found to be a reliable predictor of benefit from prophylactic ICD therapy in post hoc analyses in the MADIT II or SCD-HeFT studies (40,41).…”