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Galcerá-Jornet E, Consuegra-Sánchez L, Galcerá-Tomás J, Melgarejo-Moreno A, Gimeno-Blanes JR, Jaulent-Huertas L, Wasniewski S, de Gea-García J, Vicente-Gilabert M, Padilla-Serrano A. Association between new-onset right bundle branch block and primary or secondary ventricular fibrillation in ST-segment elevation myocardial infarction. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2021; 10:918-925. [PMID: 33993235 DOI: 10.1093/ehjacc/zuab026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 04/08/2021] [Indexed: 11/13/2022]
Abstract
AIMS New-onset right bundle branch block (RBBB) in myocardial infarction (MI) is often associated with ventricular fibrillation (VF) but the nature of this relationship has not been determined. METHODS AND RESULTS Between 1998 and 2014, among other data, incidence and duration of RBBB and VF occurrence were prospectively collected in 5301 patients with ST-segment elevation MI (STEMI) admitted to two University Hospitals in Murcia (Spain). Multinomial adjusted logistic regression analyses were used to examine the association between RBBB, attending to its duration, and VF according to its primary VF (PVF) or secondary VF (SVF) character. Among 284 (5.4%) patients with new-onset RBBB, 158 were transient and 126 permanent. VF occurred in 339 (6.4%) patients, 201 PVF and 138 SVF, documented within the first 2 h of symptoms-onset in 78% and 60%, respectively. New-onset RBBB was more frequent in PVF (11.4%) and SVF (20.3%), than in non-VF (4.7%). Transient RBBB incidence was higher in PVF (9.0%) and SVF (9.4) than in non-VF (2.6%), whereas permanent RBBB was higher in SVF (10.9%) than PVF (2.5%) and non-VF (2.1%). New-onset RBBB 1.83 [95% confidence interval (CI): 1.07-3.11] and new-onset transient RBBB 2.39 (95% CI: 1.32-4.32) were independently associated with PVF. New-onset 3.03 (95% CI: 1.83-5.02), transient 2.40 (95% CI: 1.27-4.55), and permanent 2.99 (95% CI: 1.52-5.86) RBBB were independently associated with SVF. CONCLUSION New-onset RBBB and VF in STEMI are independently associated and show particularities based on the duration of the conduction disturbance and/or the primary or secondary character of the arrhythmia.
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Affiliation(s)
- Emilio Galcerá-Jornet
- Department of Cardiology, Hospital de Denia, Av. Marina Alta, s/n, 03700 Dénia, Alicante, Spain
| | - Luciano Consuegra-Sánchez
- Department of Cardiology, Hospital Universitario Santa Lucía de Cartagena, Calle Minarete, s/n, 30202 Cartagena, Murcia, Spain
| | - José Galcerá-Tomás
- Coronary Care Unit, Department of Intensive Care Medicine, Hospital Clínico Universitario Virgen de la Arrixaca, Ctra. Madrid-Cartagena, s/n, 30120 El Palmar, Murcia, Spain
| | - Antonio Melgarejo-Moreno
- Coronary Care Unit, Department of Intensive Care Medicine, Hospital Universitario Santa Lucía de Cartagena, Calle Minarete, s/n, 30202 Cartagena, Murcia, Spain
| | - Juan Ramón Gimeno-Blanes
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Ctra. Madrid-Cartagena, s/n, 30120 El Palmar, Murcia, Spain
| | - Leticia Jaulent-Huertas
- Department of Cardiology, Hospital Universitario Santa Lucía de Cartagena, Calle Minarete, s/n, 30202 Cartagena, Murcia, Spain
| | - Samantha Wasniewski
- Department of Cardiology, Hospital Universitario Santa Lucía de Cartagena, Calle Minarete, s/n, 30202 Cartagena, Murcia, Spain
| | - José de Gea-García
- Coronary Care Unit, Department of Intensive Care Medicine, Hospital Clínico Universitario Virgen de la Arrixaca, Ctra. Madrid-Cartagena, s/n, 30120 El Palmar, Murcia, Spain
| | - Marta Vicente-Gilabert
- Emergency Department, Hospital Clínico Universitario Virgen de la Arrixaca, Ctra. Madrid-Cartagena, s/n, 30120 El Palmar, Murcia, Spain
| | - Antonio Padilla-Serrano
- Coronary Care Unit, Department of Intensive Care Medicine, Hospital Clínico Universitario Virgen de la Arrixaca, Ctra. Madrid-Cartagena, s/n, 30120 El Palmar, Murcia, Spain
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Wang J, Luo H, Kong C, Dong S, Li J, Yu H, Chu Y. Prognostic value of new-onset right bundle-branch block in acute myocardial infarction patients: a systematic review and meta-analysis. PeerJ 2018; 6:e4497. [PMID: 29576967 PMCID: PMC5853603 DOI: 10.7717/peerj.4497] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 02/22/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Patients with acute myocardial infarction (AMI) and bundle-branch block have poor prognoses. The new European Society of Cardiology guideline suggests a primary percutaneous coronary intervention strategy when persistent ischemic symptoms occur in patients with persistent ischemic symptoms and right bundle-branch block (RBBB), but the level of evidence is not high. In fact, the presence of RBBB may lead to the misdiagnosis of transmural ischemia and mask the early diagnosis of ST-elevation myocardial infarction. Moreover, new-onset RBBB is occasionally caused by AMI. Our study aims to investigate the prognostic value of new-onset RBBB in AMI. METHODS AND RESULTS We conducted a meta-analysis of studies to evaluate the prognostic value of RBBB in AMI patients. Of 914 primary records, five studies and 874 MI patients were included for meta-analysis. Compared with previous RBBB, AMI patients with new-onset RBBB had a higher risk of long-term mortality (RR, 1.66, 95% CI [1.31-2.09], I2 = 0.0%, p = 0.000, n = 2), ventricular arrhythmia (RR, 4.86, 95% CI [2.10-11.27], I2 = 0.0%, p = 0.000, n = 3), and cardiogenic shock (RR, 2.76, 95% CI [1.66-4.59], I2 = 0.0%, p = 0.000, n = 3), but a lower risk of heart failure (RR, 0.66, 95% CI [0.52-0.85], I2 = 2.50%, p = 0.001, n = 4). Compared with AMI patients with new-onset permanent RBBB, patients with new-onset transient RBBB had a lower risk of short-term mortality (RR, 0.20, 95% CI [0.11-0.37], I2 = 44.1%, p = 0.000, n = 4). CONCLUSION New-onset RBBB is likely to increase long-term mortality, ventricular arrhythmia, and cardiogenic shock, but not heart failure in AMI patients. AMI patients with new-onset transient RBBB have a lower risk of short-term mortality than those with new-onset permanent RBBB. Revascularization therapies should be considered when persistent ischemic symptoms occur in patients with RBBB, especially new-onset RBBB.
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Affiliation(s)
- Juntao Wang
- Department of Cardiology, Zhengzhou University People’s Hospital, Zhengzhou, China
| | - Hongxing Luo
- Department of Cardiology, Zhengzhou University People’s Hospital, Zhengzhou, China
| | - Chunling Kong
- Department of Cardiology, Zhengzhou University People’s Hospital, Zhengzhou, China
| | - Shujuan Dong
- Department of Cardiology, Henan Province People’s Hospital, Zhengzhou, China
| | - Jingchao Li
- Department of Cardiology, Henan Province People’s Hospital, Zhengzhou, China
| | - Haijia Yu
- Department of Cardiology, Henan Province People’s Hospital, Zhengzhou, China
| | - Yingjie Chu
- Department of Cardiology, Zhengzhou University People’s Hospital, Zhengzhou, China
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Tomoda H, Aoki N. Right Bundle Branch Block in Acute Myocardial Infarction Treated by Primary Coronary Angioplasty and Stenting. Angiology 2016; 56:131-6. [PMID: 15793601 DOI: 10.1177/000331970505600202] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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.
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Affiliation(s)
- Haruo Tomoda
- Department of Cardiology, Tokai University Hospital, Kanagawa, Japan.
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Melgarejo-Moreno A, Galcerá-Tomás J, Consuegra-Sánchez L, Alonso-Fernández N, Díaz-Pastor Á, Escudero-García G, Jaulent-Huertas L, Vicente-Gilabert M, Galcerá-Jornet E, Padilla-Serrano A, de Gea-García J, Pinar-Bermudez E. Relation of New Permanent Right or Left Bundle Branch Block on Short- and Long-Term Mortality in Acute Myocardial Infarction Bundle Branch Block and Myocardial Infarction. Am J Cardiol 2015; 116:1003-9. [PMID: 26253998 DOI: 10.1016/j.amjcard.2015.07.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 07/03/2015] [Accepted: 07/03/2015] [Indexed: 11/29/2022]
Abstract
The aim of this study was to investigate the prognosis associated with bundle branch block (BBB) depending on location, time of appearance, and duration in patients with myocardial infarction (MI). From January 1998 to January 2008, we recruited 5,570 patients with acute MI. Thirty-day and 7-year all-cause mortality, according to BBB location, time of appearance, and duration were analyzed by multivariable analyses. BBB was present in 964 patients (17.3%); right BBB (RBBB) 10.6% and left BBB (LBBB) 6.7%. Overall mortality rate at 30 days was 13.2% (n = 738) and 7 years was 6.34 deaths per 100 patient-year. Both RBBB and LBBB were more frequently previous, 42.9% and 58.8%. Compared with non-BBB, all BBB groups showed higher prevalence of co-morbidities, especially rates of diabetes (49.0% vs 34.3%, p <0.001) and more often heart failure during hospitalization (54.5% vs 26.6%, p <0.001). Compared with RBBB, patients with LBBB had a higher prevalence of co-morbidities and a higher mortality, especially the new BBB, 30 days: 52.5% versus 31.6% and 7 years (incident rate): 27.2 versus 13.3 per 100 patient-year. New transient BBB had lower heart failure on admission (42.6% vs 58.3%, p = 0.008) and 30-day mortality (20.3% vs 69.6%, p <0.001) compared with permanent in both locations. New permanent RBBB was independently associated with 30-day (hazard ratio [HR] 2.01, 95% confidence interval [CI] 1.45 to 2.79) and 7-year mortality (HR 3.12, 95% CI 2.38 to 4.09). New-permanent LBBB was independently associated with 30-day (HR 2.15, 95% CI 1.47 to 3.15) and 7-year mortality (HR 2.91, 95% CI 2.08 to 4.08). In conclusion, in patients with acute MI, the appearance of a new BBB was independently associated with a higher 30-day and 7-year all-cause mortality.
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Affiliation(s)
| | - José Galcerá-Tomás
- Coronary Care Unit, Hospital Clínico Universitario Virgen de la Arrixaca de Murcia, Murcia, Spain
| | | | | | - Ángela Díaz-Pastor
- Cardiology Department, Hospital Universitario Santa Lucía de Cartagena, Murcia, Spain
| | | | | | - Marta Vicente-Gilabert
- Coronary Care Unit, Hospital Clínico Universitario Virgen de la Arrixaca de Murcia, Murcia, Spain
| | - Emilio Galcerá-Jornet
- Coronary Care Unit, Hospital Clínico Universitario Virgen de la Arrixaca de Murcia, Murcia, Spain
| | - Antonio Padilla-Serrano
- Coronary Care Unit, Hospital Clínico Universitario Virgen de la Arrixaca de Murcia, Murcia, Spain
| | - José de Gea-García
- Coronary Care Unit, Hospital Clínico Universitario Virgen de la Arrixaca de Murcia, Murcia, Spain
| | - Eduardo Pinar-Bermudez
- Coronary Care Unit, Hospital Clínico Universitario Virgen de la Arrixaca de Murcia, Murcia, Spain
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Vivas D, Alfonso F. Bundle branch block during primary angioplasty: reperfusion success remains encrypted in the ECG! Interv Cardiol 2010. [DOI: 10.2217/ica.10.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Vivas D, Pérez-Vizcayno MJ, Hernández-Antolín R, Fernández-Ortiz A, Bañuelos C, Escaned J, Jiménez-Quevedo P, De Agustín JA, Núñez-Gil I, González-Ferrer JJ, Macaya C, Alfonso F. Prognostic implications of bundle branch block in patients undergoing primary coronary angioplasty in the stent era. Am J Cardiol 2010; 105:1276-83. [PMID: 20403479 DOI: 10.1016/j.amjcard.2009.12.044] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 12/14/2009] [Accepted: 12/14/2009] [Indexed: 10/19/2022]
Abstract
The presence of bundle branch block (BBB) in patients with ST-segment elevation myocardial infarction has been associated with a poor outcome. However, the implications of BBB in patients undergoing primary angioplasty in the stent era are poorly established. Furthermore, the prognostic implications of BBB type (right vs left and previous vs transient or persistent) remain unknown. We analyzed the data from 913 consecutive patients with ST-segment elevation myocardial infarction treated with primary angioplasty. All clinical, electrocardiographic, and angiographic data were prospectively collected. The median follow-up period was 19 months. The primary end point was the combined outcome of death and reinfarction. BBB was documented in 140 patients (15%). Right BBB (RBBB) was present in 119 patients (13%) and was previous in 27 (23%), persistent in 45 (38%), and transient in 47 (39%). Left BBB (LBBB) was present in 21 patients (2%) and was previous in 8 (38%), persistent in 9 (43%), and transient in 4 (19%). Patients with BBB were older, and more frequently had diabetes, anterior infarctions, a greater Killip class, a lower left ventricular ejection fraction, and greater mortality (all p <0.005) than patients without BBB. The short- and long-term primary outcome occurred more frequently in patients with persistent RBBB/LBBB than in those with previous or transient RBBB/LBBB. On multivariate analysis, persistent RBBB/LBBB emerged as an independent predictor of death and reinfarction. In conclusion, in patients undergoing primary angioplasty in the stent era, BBB is associated with poor short- and long-term prognosis. This risk appears to be particularly high among patients with persistent BBB.
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Melgarejo-Moreno A, Galcerá-Tomás J, Garcia-Alberola A. Prognostic significance of bundle-branch block in acute myocardial infarction: the importance of location and time of appearance. Clin Cardiol 2009; 24:371-6. [PMID: 11346244 PMCID: PMC6655020 DOI: 10.1002/clc.4960240505] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The presence of bundle-branch block (BBB) is associated with high mortality rates and is considered an important predictor of poor outcome in patients with acute myocardial infarction (AMI). HYPOTHESIS The objective of this study was to assess the prognostic significance of BBB in patients with AMI depending on its form of presentation. METHODS A multicenter prospective 1-year follow-up study involving 1,239 consecutive patients diagnosed with AMI was performed. RESULTS Bundle-branch block was present in 177 cases (14.2%), associated with worse clinical characteristics, lower rate of thrombolytic therapy, and higher mortality: in-hospital (23.8 vs. 9.7%, p < .01) and 1-year (40.9 vs. 16.9%, p < 0.01). Compared with right BBB (n = 135), left BBB (n = 42) was more often associated with female gender and higher prevalence of cardiovascular diseases, but had a similar 1-year mortality. In the absence of heart failure or complete atrioventricular (AV) block, there was no difference in in-hospital mortality of patients with BBB (n = 76) and without BBB (n = 786) (2.6 vs. 3.9%). Compared with existing BBB (n = 113), BBB of new appearance (n = 64) was more often accompanied by complete AV block and heart failure and higher in-hospital and 1-year mortality rates. Only BBB of new appearance was an independent predictor of mortality: in-hospital (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.1-4.7) and 1-year mortality (OR 3.2, 95% CI, 1.7-9.1). CONCLUSIONS In patients with AMI, the classification of BBB according not only to location but also to time of appearance is of practical interest. New BBB is an independent predictor of short- and long-term mortality.
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Bogale N, Orn S, James M, McCarroll K, de Luna AB, Dickstein K. Usefulness of either or both left and right bundle branch block at baseline or during follow-up for predicting death in patients following acute myocardial infarction. Am J Cardiol 2007; 99:647-50. [PMID: 17317365 DOI: 10.1016/j.amjcard.2006.09.113] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2006] [Revised: 09/28/2006] [Accepted: 09/28/2006] [Indexed: 10/23/2022]
Abstract
The presence or onset of bundle branch block (BBB) is associated with increased mortality in patients after acute myocardial infarction (AMI). The risk increases with age. We assessed the prognostic power of BBB patterns for predicting clinical outcomes in patients after high-risk AMI. In the OPTIMAAL trial, the effects of losartan versus captopril were compared in 5,477 patients with heart failure and/or evidence of left ventricular dysfunction after MI. The association between clinical outcomes and the presence of left or right BBB at randomization (median 3 days after AMI) or occurring during follow-up (mean 2.7 years) was assessed using Cox regression models. At randomization, 8% of patients (n = 438) showed BBB patterns; 3.7% (n = 203) showed left BBB and 4.3% (n = 235) showed right BBB patterns. In patients with left BBB, there was an increased risk of all-cause death and cardiovascular death. In patients with right BBB, there was increased risk of sudden cardiac death/resuscitated cardiac arrest. During follow-up, another 4.9% (n = 272) developed BBB patterns; 2.8% (n = 153) developed left BBB and 2.17% (n = 119) developed right BBB. Left BBB was associated with increased risk for all-cause death, cardiovascular death, and sudden cardiac death/resuscitated cardiac arrest, whereas right BBB was related to increased risk of sudden cardiac death/resuscitated cardiac arrest. In conclusion, our results confirm and quantify previous observations showing substantially increased mortality in patients with BBB patterns at baseline or occurring soon after AMI.
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Affiliation(s)
- Nigussie Bogale
- Stavanger University Hospital, Department of Cardiology, Stavanger, Norway.
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Kurisu S, Inoue I, Kawagoe T, Ishihara M, Shimatani Y, Hata T, Nakama Y, Kijima Y, Kagawa E. Right bundle-branch block in anterior acute myocardial infarction in the coronary intervention era: Acute angiographic findings and prognosis. Int J Cardiol 2007; 116:57-61. [PMID: 16815572 DOI: 10.1016/j.ijcard.2006.02.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2005] [Revised: 02/11/2006] [Accepted: 02/24/2006] [Indexed: 11/21/2022]
Abstract
BACKGROUND Previous studies in the prethrombolytic or thrombolytic era have reported that right bundle-branch block (RBBB) is associated with poor clinical outcome in patients with acute myocardial infarction (AMI). METHODS AND RESULTS The purpose of this study was to examine the relations between RBBB and angiographic findings or clinical outcomes in patients with AMI in the coronary intervention era. A total of 430 patients with a first anterior AMI who underwent coronary angiography within 12 h after the onset were enrolled in this study. Seventy-one patients (17%) had RBBB documented during their hospital stay. RBBB was documented on admission in 35 patients. Patients with RBBB were older (p<0.01) and had prodromal angina less frequently (p=0.03) than those without. On the initial angiograms, patients with RBBB had an occluded left anterior descending artery (p<0.01) and multivessel disease (p=0.01) more frequently than those without. Thirty-day mortality rate was significantly higher in patients with RBBB than in those without (14.0% vs 1.9%, p<0.01). Multiple logistic-regression analysis demonstrated that RBBB (odds ratio 5.89, p<0.01) and multivessel disease (odds ratio 4.36, p=0.01) were independent predictors of 30-day mortality. CONCLUSIONS Our data suggested that RBBB was still associated with poor clinical outcome in patients with anterior AMI even in the coronary intervention era.
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Affiliation(s)
- Satoshi Kurisu
- Department of Cardiology, Hiroshima City Hospital, 7-33, Moto-machi, Naka-ku, Hiroshima, 730-8518 Japan.
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Alfonso F. Immediate resolution of new right bundle branch block in acute myocardial infarction following primary coronary angioplasty. Int J Cardiol 2005; 105:117-8. [PMID: 16207561 DOI: 10.1016/j.ijcard.2004.12.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2004] [Accepted: 12/31/2004] [Indexed: 10/25/2022]
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Melgarejo Moreno A, Galcerá Tomás J, García Alberola A, Gil Sánchez J, Martínez Hernández J, Rodríguez Fernández S, Ortín Katnich L, Murcia Payá JF. [Prognostic significance of the implantation of a temporary pacemaker in patients with acute myocardial infarction]. Rev Esp Cardiol 2001; 54:949-57. [PMID: 11481109 DOI: 10.1016/s0300-8932(01)76430-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Indication of temporary pacemakers in patients during acute myocardial infarction was widely studied in the pre-thrombolytic era without having determined whether the generalization of fibrinolysis might have changed the overall incidence and significance of temporary pacemakers. Our aim was to determine the incidence and the prognostic significance of insertion of temporary pacemakers in patients with acute myocardial infarction. PATIENTS AND METHODS In a study involving 1,239 patients consecutively admitted to hospital with acute myocardial infarction we studied clinical characteristics and prognosis depending on temporary pacemaker insertion or not. We performed an univariate analysis on in-hospital mortality and those selected variables were introduced in to a logistic regression analysis. RESULTS A temporary pacemaker was indicated in 55 patients (4.4%), prophylactically in 22% and therapeutically in 78%. Temporary pacemakers were inserted in 55% of the patients with advanced AV block and in the 10% of the patients with bundle-branch block. Pacemaker insertion was associated with higher number of affected leads in the ECG, and higher CK peak, regardless of the association with thrombolysis. The following complications were more often observed in patients with temporary pacemakers: atrial fibrillation, heart failure, right bundle-branch block, advanced atrioventricular block and in-hospital mortality (45.4 vs 10.2%; p < 0.001). Need for a temporary pacemaker was less frequent in patients treated with thrombolytics compared with those not treated (3.0 vs 6.1%; p < 0.02). Pacemaker insertion had an independent value for predicting in-hospital mortality (OR = 5.51; 95% CI, 2.71-11.19). CONCLUSION The insertion of a temporary pacemaker in acute myocardial infarction is less frequent nowadays than on the pre-thrombolytic era. Pacemaker insertion is associated with higher indices of infarct extension and in-hospital mortality, having independent prognostic value on the in-hospital mortality.
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Affiliation(s)
- A Melgarejo Moreno
- Servicio de Medicina Intensiva, Unidad Coronaria, Hospital Santa María del Rosell, Cartagena
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Mininni SM, Wood JP. The significance of a new right bundle branch block in a patient with acute chest pain. Acad Emerg Med 1999; 6:1180-2. [PMID: 10569395 DOI: 10.1111/j.1553-2712.1999.tb00126.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Melgarejo Moreno A, Galcerá Tomás J, García Alberola A, González Sánchez A, Jiménez Pagán F, Vignote Mingorance G, Galán Ayuso J, Rodríguez García P. [The incidence, clinical characteristics and prognostic significance of a left bundle-branch block associated with an acute myocardial infarct]. Rev Esp Cardiol 1999; 52:245-52. [PMID: 10217965 DOI: 10.1016/s0300-8932(99)74906-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
To assess the current incidence and meaning of left bundle-branch block associated with acute myocardial infarction we studied 1,239 patients consecutively admitted in three hospitals. Left bundle branch block was present in 42 cases (3.3%). Compared to the patients without left bundle-branch block, those with left bundle-branch block were older (70 +/- 8.8 versus 63.9 +/- 11.4 years; p < 0.001), and had a more prevalent history of diabetes, angina, myocardial infarction and heart failure. Left bundle-branch block was associated more frequently with female gender and poor left ventricular ejection fraction. Patients with left bundle branch block were admitted with a longer interval from the onset of the symptoms (7.8 +/- 6.3 versus 5.4 +/- 6.7 hours; p < 0.01) and received in a lesser rate thrombolytics agents (21% versus 56%; p < 0.001), than those without left bundle-branch block. Complications significatively associated with left bundle-branch block were: complete AV block; heart failure and one-year mortality (40.4% versus 19.5%, p < 0.01). Female gender, age and heart failure were independent predictors of mortality whereas left bundle-branch block was not. In conclusion, current incidence of left bundle-branch block in acute myocardial infarction is lower than that referred in the pre-thrombolytic era. Left bundle-branch block is accompanied by a low rate of thrombolysis, whereas a higher mortality rate of these patients seems to depend on their clinical characteristics.
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Affiliation(s)
- A Melgarejo Moreno
- Servicio de Medicina Intensiva, Unidad Coronaria, Hospital Santa María del Rosell, Murcia
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Simons GR, Sgarbossa E, Wagner G, Califf RM, Topol EJ, Natale A. Atrioventricular and intraventricular conduction disorders in acute myocardial infarction: a reappraisal in the thrombolytic era. Pacing Clin Electrophysiol 1998; 21:2651-63. [PMID: 9894656 DOI: 10.1111/j.1540-8159.1998.tb00042.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sgarbossa EB, Pinski SL, Topol EJ, Califf RM, Barbagelata A, Goodman SG, Gates KB, Granger CB, Miller DP, Underwood DA, Wagner GS. Acute myocardial infarction and complete bundle branch block at hospital admission: clinical characteristics and outcome in the thrombolytic era. GUSTO-I Investigators. Global Utilization of Streptokinase and t-PA [tissue-type plasminogen activator] for Occluded Coronary Arteries. J Am Coll Cardiol 1998; 31:105-10. [PMID: 9426026 DOI: 10.1016/s0735-1097(97)00446-4] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES We sought to assess the outcome of patients with acute myocardial infarction (MI) and bundle branch block in the thrombolytic era. BACKGROUND Studies of patients with acute MI and bundle branch block have reported high mortality rates and poor overall prognosis. METHODS The North American population with acute MI and bundle branch block enrolled in the Global Utilization of Streptokinase and t-PA [tissue-type plasminogen activator] for Occluded Coronary Arteries (GUSTO-I) trial was matched by age and Killip class with an equal number of GUSTO-I patients without conduction defects. RESULTS Of all 26,003 North American patients in GUSTO-I, 420 (1.6%) had left (n = 131) or right (n = 289) bundle branch block. These patients had higher 30-day mortality rates than matched control subjects (18% vs. 11%, p = 0.003, odds ratio [OR] 1.8) and were more likely to experience cardiogenic shock (19% vs. 11%, p = 0.008, OR 1.78) or atrioventricular block/asystole (30% vs. 19%, p < 0.012, OR 1.57) and to require ventricular pacing (18% vs. 11%, p = 0.006, OR 1.73). Bundle branch block also carried an independent 53% higher risk for 30-day mortality. Thirty-day mortality rates for patients with complete, partial and no reversion of the bundle branch block were 8%, 12% and 20%, respectively (two-tailed chi-square test for trend 5.61, p = 0.02, OR 0.34 for complete reversion, OR 0.55 for partial reversion). CONCLUSIONS Bundle branch block at hospital admission in patients with acute MI predicts in-hospital complications and poor short-term survival.
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Moreno AM, Alberola AG, Tomás JG, Chávarri MV, Soria FC, Sánchez EM, Sánchez JG. Incidence and prognostic significance of right bundle branch block in patients with acute myocardial infarction receiving thrombolytic therapy. Int J Cardiol 1997; 61:135-41. [PMID: 9314206 DOI: 10.1016/s0167-5273(97)00138-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We assessed the incidence and prognostic significance of right bundle branch block (RBBB) in patients with acute myocardial infarction (AMI) receiving thrombolytic therapy. A prospective, one-year follow-up study involving 681 consecutive patients treated with thrombolytic agents for AMI was performed. Seventy-four patients developed RBBB (46% new-onset, 24% old and 30% indeterminate). RBBB was more common in older patients with large anterior AMI. New-onset RBBB were often transient (56%) and 84% of them resolved within 12 h after admission. Complicating events during the hospital phase, such as ventricular arrhythmias and development of heart failure, were more frequent in patients with RBBB. In-hospital and one-year mortality were higher in patients with RBBB (22.9 and 40.5% compared to 7.9 and 12.3% respectively in patients without block, both p<0.001). New-onset, non-transient RBBB were associated with the highest mortality rates (73% at one-year follow-up). By multivariate analysis, RBBB was retained as independent predictor of in-hospital and one-year mortality. We conclude that new-onset RBBB in patients receiving thrombolytic therapy for AMI is often transient. The development of RBBB has a negative and independent prognostic impact on the survival during the hospital phase and at one-year follow-up.
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Affiliation(s)
- A M Moreno
- Department of Cardiology, Hospital del Rosell, Cartagena, Spain
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Melgarejo-Moreno A, Galcerá-Tomás J, Garciá-Alberola A, Valdés-Chavarri M, Castillo-Soria FJ, Mira-Sánchez E, Gil-Sánchez J, Allegue-Gallego J. Incidence, clinical characteristics, and prognostic significance of right bundle-branch block in acute myocardial infarction: a study in the thrombolytic era. Circulation 1997; 96:1139-44. [PMID: 9286941 DOI: 10.1161/01.cir.96.4.1139] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Whereas the significance of right bundle-branch block (RBBB) in acute myocardial infarction was extensively studied in the prethrombolytic era, a possible change in the overall incidence and meaning of RBBB as a consequence of thrombolytic therapy is not well known. METHODS AND RESULTS A multicenter, prospective study of 1238 patients consecutively diagnosed with acute myocardial infarction and admitted to three coronary care units was conducted. ECGs during the acute phase and clinical events until discharge and 1-year follow-up were monitored. In the 135 (10.9%) patients in whom RBBB was found, there were 51 (37.8%) new cases, 46 (34.1%) old cases, and 38 (28.1%) cases with an indeterminate time of origin. New RBBB was permanent in 26 and transient in 25 patients. RBBB was isolated in 76 (56%) and bifascicular in the remaining 59 (44%) patients. The following complications were more frequently associated with RBBB than non-RBBB patients: heart failure, 24% versus 46% (P<.001); use of pacemaker because of atrioventricular block, 3.6% versus 11% (P<.001); and 1-year mortality, 17.6% versus 40.7% (P<.001). Early mortality was significantly higher for new RBBB (43.1%, P<.001) than for old (15.5%) and indeterminate (15.3%) RBBB. These figures for 1-year mortality were 58.8% (P<.001), 35.5 (P<.01), and 23% (NS), respectively. Permanent and transient RBBB had different mortality rates: early mortality, 76% versus 8%, and 1-year mortality, 84% versus 32% (P<.001 for both). For isolated RBBB versus bifascicular block, early mortality was 14.4% versus 40.6%, and 1-year mortality was 30.2% versus 54.2% (P<.05 for both). Multivariate analysis showed an independent prognostic value of RBBB for early and 1-year mortality. CONCLUSIONS The overall meaning of RBBB in acute myocardial infarction has not changed in the thrombolytic era, although a higher rate of new and transient RBBB and a lower rate of bifascicular block may represent a beneficial effect of thrombolytic therapy.
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Newby KH, Pisanó E, Krucoff MW, Green C, Natale A. Incidence and clinical relevance of the occurrence of bundle-branch block in patients treated with thrombolytic therapy. Circulation 1996; 94:2424-8. [PMID: 8921783 DOI: 10.1161/01.cir.94.10.2424] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Whether thrombolytic therapy alters the incidence and clinical outcome of bundle-branch block is unclear. METHODS AND RESULTS We examined the occurrence of new-onset bundle-branch block, both transient and persistent, in 681 patients with acute myocardial infarction enrolled in the Thrombolysis and Angioplasty in Myocardial Infarction 9 and Global Utilization of Streptokinase and t-PA for Occluded Arteries 1 protocols. Each patient underwent continuous 12-lead ECG monitoring for 36 to 72 hours with the Mortara ST monitoring system. Bundle-branch block was characterized as right, left, alternating, transient, or persistent. The overall incidence of bundle-branch block was 23.6% (n = 161), with transient block in 18.4% (n = 125) and persistent block in 5.3% (n = 36). Right bundle-branch block was found in 13% (n = 89) of the population; left bundle-branch block was found in 7% (n = 48). Alternating bundle-branch block was seen in 3.5% (n = 24) of patients. Left anterior descending artery infarcts accounted for most bundles (54%, n = 79). Patients with bundle-branch block had lower ejection fractions, higher peak creatine phosphokinase levels (P < .0001), and more diseased vessels (P < .019). Mortality rates in patients with and without bundle-branch block were 8.7% and 3.5%, respectively (P < .007). A higher mortality rate was observed in the presence of persistent (19.4%) versus transient (5.6%) or no (3.5%) bundle-branch block (P < .001). CONCLUSIONS Thrombolytic therapy reduces the overall mortality rate associated with persistent bundle-branch block. However, persistent bundle-branch block remains predictive of a higher mortality rate than either transient or no bundle-branch block. Continuous 12-lead ECG monitoring provides an accurate characterization of the incidence and type of conduction disturbances after acute myocardial infarction.
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Affiliation(s)
- K H Newby
- Duke University/VA Medical Center, Durham, NC, USA
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