Incidence and prognostic significance of right bundle branch block in patients with acute myocardial infarction receiving thrombolytic therapy

Moreno, Antonio; Alberola, Arcadi Garcı́a; Tomás, José Galcerá; Chávarri, Mariano Valdés; Soria, F. Castillo; Sánchez, Enrique Mira; Sánchez, Javier Gil

doi:10.1016/s0167-5273(97)00138-1

Cited by 18 publications

(7 citation statements)

References 23 publications

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“…[13][14][15][16][17][18][19][20] Thus, the literature refers to the clinical characteristics, incidence, new vs old RBBB, persisting vs transient RBBB, its association with inferior vs anterior AMI, and short-term vs long-term mortality of patients in the current thrombolytic era. [13][14][15][16][17][18][19][20] PMI is often inappropriately managed, even when uncomplicated by bundle-branch block, by failing to provide thrombolysis, due to the preoccupation in practice and design of trials in administering such therapy to patients with AMI and ST-segment elevations in the ECG. 21 In this context, it is even more imperative to diagnose PMI, an AMI often missed when it occurs in association with RBBB.…”

Section: Discussionmentioning

confidence: 99%

Posterior Myocardial Infarction and Complete Right Bundle- Branch Block

Madias

Bravidis

Attari

2002

Chest

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Section: Discussionmentioning

confidence: 99%

Posterior Myocardial Infarction and Complete Right Bundle- Branch Block

Madias

Bravidis

Attari

2002

Chest

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“…Later, in the thrombolytic era, patients with ST elevation AMI (STEMI) complicated by RBBB or complete LBBB still maintained a short-term prognosis significantly worse than the individuals without acute bundle branch block [3,4]. On the other hand, the first reports on this subject from the mechanical reperfusion era persistently revealed a significantly higher short-term mortality in STEMI patients with acute RBBB or complete LBBB [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Intraventricular conduction defects in acute myocardial infarction. What is the influence of primary coronary angioplasty on their prognosis?

Bordalo¹,

Bordalo-Sá²,

Correia³

et al. 2017

Vascul Dis Ther

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Introduction and objective: In the pre-thrombolytic era, patients (pts) with a major intraventricular conduction defect (IVCD) -right bundle branch block (RBBB), left bundle branch block (LBBB), left posterior hemiblock (LPH), advanced (QRS > 105 msec) left anterior hemiblock (LAH) or left IVCD with normal axis and QRS > 115 msec -acquired during ST-segment elevation myocardial infarction (STEMI) very frequently had a poor in-hospital prognosis. The objective of this study is to evaluate, in an era characterized by the prominent use of emergent mechanical coronary reperfusion in STEMI, what is the impact of emergent coronary angioplasty (CA) on the prognosis of pts with STEMI complicated by IVCD.

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“…Right bundle branch block (RBBB) has been reported in 6% to 13% of patients with acute myocardial infarction (AMI), and the existence of RBBB in AMI is associated with a marked increase in in-hospital complications and mortality. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] Because of its dual blood supply, the development of RBBB in AMI indicates an extensive myocardial infarction. 7 Thus, transient and persistent RBBB in AMI reflects the ischemic process and viability of the myocardium, playing a role as a marker of myocardial ischemic insult in AMI.…”

Section: Introductionmentioning

confidence: 99%

“…Early mortality rates of patients with RBBB in AMI were as high as 31-71%, [1][2][3][4][5][6][7] but the mortality rate has been reduced to 13-32% with the advent of thrombolytic therapy. [8][9][10][11][12][13][14] The beneficial effects of thrombolytic therapy may be attenuated by the presence of patients contraindicated for the therapy and by occasional incomplete recanalization. With the application of primary percutaneous transluminal coronary angioplasty (PTCA) and stenting, complete recanalization of the infarctrelated coronary artery with minimal exclusion of candidates has become possible, and outcomes are significantly more favorable than those for thrombolytic therapy in most studies.…”

Section: Introductionmentioning

confidence: 99%

Right Bundle Branch Block in Acute Myocardial Infarction Treated by Primary Coronary Angioplasty and Stenting

Tomoda

Aoki

2005

Angiology

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Patients with right bundle branch block (RBBB) in acute myocardial infarction (AMI) have a significantly higher mortality rate even with the advent of thrombolytic therapy. This study was undertaken to assess the impact of primary percutaneous transluminal coronary angioplasty (PTCA) and stenting on the outcome of patients with RBBB in AMI. A total of 600 patients with AMI who underwent primary PTCA and stenting (rate: 61%) < 12 hours of onset were studied. A 12-lead ECG was obtained at least every 6 hours. Serial creatine kinase was measured, and left ventricular ejection fraction was obtained during the hospital stay. Among 600 patients with AMI, 94 patients (15.7%) had RBBB; it was persistent in 31 (33%) and transient in 63 (67%). In-hospital mortality rate was 7.3% in patients without RBBB, 7.9% in transient RBBB, and 25.8% in persistent RBBB (p < 0.02). The incidence of heart failure was 26.5% in those without RBBB, 34.9% in transient RBBB, and 58.1% in persistent RBBB (p < 0.001). There was no significant difference among these 3 groups in ventricular arrhythmias and complete atrioventricular block. Peak creatine kinase was 3,214+/-2,293 U/L in those without RBBB, 4,558+/-3,316 U/L in transient RBBB (p < 0.001), and 5,635+/-3,920 U/L in persistent RBBB (p < 0.001). Left ventricular ejection fraction was 50+/-11% in those without RBBB, 47+/-11% in transient RBBB (p < 0.05), and 42+/-13% in persistent RBBB (p < 0.001). Patients with AMI treated by primary PTCA and stenting had an increased incidence of transient RBBB, especially following reperfusion therapy, although the clinical outcome was similar to that of those without RBBB. In contrast, there was no satisfactory improvement in clinical outcomes in those with persistent RBBB.

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Incidence and prognostic significance of right bundle branch block in patients with acute myocardial infarction receiving thrombolytic therapy

Cited by 18 publications

References 23 publications

Posterior Myocardial Infarction and Complete Right Bundle- Branch Block

Posterior Myocardial Infarction and Complete Right Bundle- Branch Block

Intraventricular conduction defects in acute myocardial infarction. What is the influence of primary coronary angioplasty on their prognosis?

Right Bundle Branch Block in Acute Myocardial Infarction Treated by Primary Coronary Angioplasty and Stenting

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