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

Abstract

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.

Prognostic significance of acute bundle branch block in patients with acute myocardial infarction

“…Akutni blok grane je prediktor povećanog IH mortaliteta i mortaliteta u dugoročnom praćenju 11,12 . Mortalitet kod bolesnika sa ABG u odnosu na bolesnike bez ABG značajno ;e['e javlja u intrahospitalno, nakon 30 dana, u jednogodišnjem praćenju i u petogodišnjem praćenju 1,3,4,6 .…”

“…U našoj studiji ovi bolesnici nisu imali veći mortalitet u praćenju, verovatno zbog veoma visokog intrahospitalnog mortaliteta. Drugi autori, takođe, našli su da je ABDG praćen povišenim intrahospitalnim mortalitetom, ali i povišenim mortalitetom tokom praćenja 1,3,4,6 .…”

Cardiomyopathy and Death Following Chikungunya Infection: An Increasingly Common Outcome

“…While this is not a definitive confirmation of cardiac distress, some patients received electrocardiograms, showing repolarization disturbances, poor R wave progression, and/or right bundle branch block [ 67 , 71 , 85 ]. Repolarization disturbances refers to alterations in the charging to membrane potential in the heart, R wave progression refers to the QRS complex, and the right bundle branch block refers to clotting [ 93 , 94 ]. Some patients received echocardiograms, showing altered left ventricular (LV) ejection fraction, hypo-contractility, and/or dilated LV cardiomyopathy [ 67 , 68 , 71 ].…”

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

“…The implementation of an effective reperfusion therapy -as primary CA is -in the first hours of STEMI evolution allowed the transitoriness of an intraventricular conduction defect to become much more frequent nowadays [5].…”

“…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].…”