Prognostic differences between different types of bundle branch block during the early phase of acute myocardial infarction: insights from the Hirulog and Early Reperfusion or Occlusion (HERO)-2 trial

Wong, Cheuk‐Kit; Stewart, Ralph; Gao, Wanzhen; French, John K.; Raffel, Corey; White, Harvey D.

doi:10.1093/eurheartj/ehi622

Cited by 110 publications

(99 citation statements)

References 25 publications

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“…8 All ECGs were sent to the core ECG laboratory at Green Lane Hospital, Auckland, New Zealand, for analysis. 2,8,12 Eight experienced ECG technicians screened all trial patients to identify those with any widening of the QRS on any of the paired ECGs. These ECGs were reviewed by a cardiologist (CKW) to identify the current cohort who had bundle-branch block at either of the 2 time points.…”

Section: Methodsmentioning

confidence: 99%

“…These ECGs were reviewed by a cardiologist (CKW) to identify the current cohort who had bundle-branch block at either of the 2 time points. 2 The present study was predefined before data lock. 2 …”

Section: Methodsmentioning

confidence: 99%

“…1 In the Hirulog Early Reperfusion Occlusion (HERO-2) trial, we examined 2 groups of patients-those with RBBB at randomization and those who developed new RBBB 60 minutes after fibrinolytic therapy was begun-and confirmed a 3-to 4-fold higher 30-day mortality rate than among patients with normal intraventricular conduction. 2 Whether other ECG findings would aid risk stratification was unknown.…”

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confidence: 99%

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Risk Stratification of Patients With Acute Anterior Myocardial Infarction and Right Bundle-Branch Block

et al. 2006

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on behalf of the Hirulog Early Reperfusion Occlusion (HERO-2) Investigators Background-Patients with an acute anterior ST-segment elevation myocardial infarction and right bundle-branch block (RBBB) have a high mortality risk, which may be stratified by early ECG changes. Methods and Results-In the Hirulog Early Reperfusion Occlusion (HERO-2) trial, 17 073 patients with acute myocardial infarction (AMI) within 6 hours of symptom onset were treated with streptokinase and randomized to receive bivalirudin or heparin. There was no difference in the primary end point of 30-day mortality. ECGs were recorded at randomization and 60 minutes after fibrinolytic therapy was begun. The 30-day mortality rate was 31.6% in the 415 patients with RBBB and anterior AMI at randomization and 33% in the 100 patients who developed new RBBB at 60 minutes from normal baseline conduction accompanying an anterior AMI. An increase in QRS duration by 20-ms increments was associated with increasing 30-day mortality rate in both RBBB groups on multivariable analyses with covariates of age, Killip class, systolic blood pressure, pulse, and prior infarction. Patients with QRS duration Ն160 ms had higher 30-day mortality rate than those with QRS duration Ͻ160 ms (37.2% versus 27.2%, Pϭ0.03, and 46.2% versus 24.5%, Pϭ0.025, in the 2 groups, respectively). For the patients with RBBB and anterior MI at randomization, RBBB resolved at 60 minutes in 40 patients, but 30-day mortality rate was unchanged.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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Risk Stratification of Patients With Acute Anterior Myocardial Infarction and Right Bundle-Branch Block

et al. 2006

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“…Escoteguy et al 19 in 1992 studied the bundle branch & AV block as complications of acute MI in thrombolytic era, and mean age of studied population was 59.9±15.2 years. Newby et al 13 Site of infarct :In our study blocks involving the BBB were more common in anterior infarction (table 7) but blocks at the atrioventricular node occurred predominantly in inferior infarction (table 13).…”

Section: Agementioning

confidence: 99%

Acute Myocardial Infarction with Bundle Branch Block (Rbbb or Lbbb) - Clinical Characteristics, Complications & Prognostic Significance - A Hospital Based Study

Gupta¹,

Shelke²

2017

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“…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%.…”

Section: Left Bundle-branch Block and Risk Stratification In Heart DImentioning

confidence: 99%

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

Francia

Balla

Paneni

et al. 2007

Clinical Cardiology

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Summary: Given its broad use as a screening tool, the electrocardiogram (ECG) has largely become one of the most common diagnostic tests performed in routine clinical practice. As a result, the finding of left bundle-branch block (LBBB) in the absence of a well-defined clinical setting has become relatively frequent and raises questions and often concerns. While in the absence of clinically detectable heart disease LBBB does not necessarily imply poor outcomes, physicians should be aware of the role of LBBB in stratifying risk of cardiovascular events and death in subjects with both ischemic and nonischemic heart disease. This paper reviews historical landmarks, pathophysiologic features, prognostic implications, and clinical management of LBBB in apparently healthy subjects and those with heart disease. Evolving Concepts, Misunderstandings, and Current Appraisal of Left Bundle-Branch BlockAs early as the beginning of the past century, Eppinger and Tothberger, by means of a rudimental but efficient experimental model, performed experiments destroying pieces of dog myocardium by injecting silver nitrate and then observing the induced electrocardiographic (ECG) changes. 1 By means of a single esophageal-anal lead, these and other investigators found that injuring the left and right bundle branches resulted, respectively, in an upward and a downward QRS deflection on ECG. 2 Ironically, the mere extrapolation of data obtained from this experimental canine model resulted in a 25-year misunderstanding of the real electrical abnormalities. Left bundle-branch block (LBBB) pattern was incorrectly identified as right bundle-branch block (RBBB), and vice versa. In fact, since the esophageal-anal lead was erroneously judged to be "vertical" in the dog, the presence in humans of a wide downward deflection in leads II and III was considered to disclose RBBB. 3 Almost 70 years after elucidation of this long-lasting misinterpretation, the electrogenesis and ECG pattern of LBBB appear to be fully clarified. Under normal conditions, the electrical impulse from the His bundle passes through a narrow anterior fascicle, a broader early branching posterior fascicle, and a third septal segment composed of many branches originating from each of the fascicles. The electrical impulse then spreads through a rich peripheral Purkinje network that couples with individual myocardial cells. 4,5 The simultaneous electrical activation of the right ventricle from its own branch results in the QRS complex, which then represents the "sum" of two parallel and independent electrical phenomena. Left bundle-branch block completely modifies the electrical activation of the left ventricle and QRS complex on ECG. The activation of the interventricular septum, which is left-sided in physiologic conditions, originates on its right side. The electrical impulse propagates then inferiorly, to the left, and slightly anteriorly. This results in a nonhomogeneous and delayed depolarization of the left ventricle, which can be only partially preserved in the presen...

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Prognostic differences between different types of bundle branch block during the early phase of acute myocardial infarction: insights from the Hirulog and Early Reperfusion or Occlusion (HERO)-2 trial

Abstract: RBBB accompanying anterior AMI at presentation and new BBB (including LBBB) early after fibrinolytic therapy are independent predictors of high 30-day mortality. These electrocardiographic features should be considered in risk stratification to identify high-risk patients.

Cited by 110 publications

References 25 publications

Risk Stratification of Patients With Acute Anterior Myocardial Infarction and Right Bundle-Branch Block

Risk Stratification of Patients With Acute Anterior Myocardial Infarction and Right Bundle-Branch Block

Acute Myocardial Infarction with Bundle Branch Block (Rbbb or Lbbb) - Clinical Characteristics, Complications & Prognostic Significance - A Hospital Based Study

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

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