Complete Bundle-Branch Block Complicating Acute Myocardial Infarction

Godman, M J; Lassers, B. W.; Julian, Desmond G.

doi:10.1056/nejm197001292820502

Cited by 141 publications

(26 citation statements)

References 9 publications

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“…Of particular interest is that the 30-day mortality was remarkably higher in the patients with ECG expression of complete BBB than in those without even undergoing primary PCI. Therefore, the findings of the current study, in addition to reinforcing those of the previous studies, 6,7,22,23) highlight the important role of new-onset CLBBB and CRBBB in predicting unfavorable clinical outcomes for AMI patients.…”

Section: Discussionsupporting

confidence: 86%

“…Our findings were consistent with those from previous studies. 6,7,22) Second, the current study showed that lower R-wave voltage of precordial leads 24 hours after AMI was strongly associated with poorer LVEF, higher peak serum CPK level, increased incidence of advanced Killip core, and more advanced CHF. Third, of importance was the fact that change of R-wave voltage in V 1 -V 6 was strongly and independently predictive of 30-day MACE in patients with AMI undergoing primary PCI.…”

Section: Discussionmentioning

confidence: 59%

“…22,23) However, whether new-onset CLBBB or CRBBB after AMI in the modern reperfusion era (ie, by means of primary PCI) is still an important predictor of untoward clinical outcome has not been fully studied. 6,7) One important finding in the present study is that patients with ECG presentation of either CLBBB or CRBBB had significantly higher incidences of advanced Killip score upon presentation, advanced CHF, higher peak serum CPK level, and more severe LV dysfunction compared with those without these ECG findings.…”

Section: Discussionmentioning

confidence: 99%

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Prognostic Value of R-Wave Voltage in Patients With Anterior Wall ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

et al. 2010

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SummaryThe prognostic value of integrated R-wave voltages of precordial leads (V 1 -V 6 ) in patients with acute anterior wall ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) was investigated.Between July 2006 and October 2009, 292 patients with anterior wall STEMI with presentation < 12 hours underwent primary PCI. Thirty-four patients with electrocardiographic presentation of either complete right bundle branch block (BBB) or complete left BBB were categorized into group A, while the remaining 258 patients without BBB served as group B that was further subdivided into those with lower R-wave voltage (summation of V 1 -V 6 ≤ 1.7 mV) (group 1) and higher voltage (> 1.7 mV) (group 2) according to the ROC curve (sensitivity = 66.3%, specificity = 66%, P < 0.0001).While the procedural success rate was similar between groups A and B and groups 1 and 2, 30-day mortality was higher in group A than B (P ≤ 0.0001). Additionally, left ventricular ejection fraction (LVEF) was lower, whereas peak level of creatine phosphopkinase (CPK), incidence of advanced congestive heart failure, and 30-day mortality were higher in group 1 than 2 (P < 0.01). Multivariate analysis revealed that lower R-wave voltage, multivessel disease, leukocyte count, peak CPK, and creatinine level were predictive of 30-day unfavorable clinical outcomes (all P < 0.01). Rwave voltage in precordial leads was a significant independent predictor of 30-day prognostic outcome in patients with anterior wall STEMI undergoing primary PCI. (Int Heart J 2010; 51: 325-330) Key words: Electrocardiogram, Acute myocardial infarction, R-wave voltage, 30-day major adverse cardiac events I t is well known that the electrocardiogram (ECG), which was first developed more than 100 years ago, 1) is a useful noninvasive tool for the diagnosis of various cardiac disorders in daily clinical practice.2-5) Some distinctive ECG findings, including new onset of complete left bundle branch block (CLBBB), 6) combined expression of pathological Q-wave and complete right bundle branch block (CRBBB), 7) ST-segment elevation ≥ 1 mV in aVR lead, 8) inferior wall myocardial infarction (MI) complicated by right ventricular infarction, 9) and simultaneous inferior wall and anterior wall ST-segment elevation, 10) have been shown to be useful ECG features for the prediction of prognosis after acute myocardial infarction (AMI). Recently, the resolution of elevated ST-segments in patients with acute ST-elevation MI (STEMI) undergoing primary percutaneous coronary intervention (PCI) has also been identified as an important marker of ECG for assessing left ventricular (LV) function and prognostic outcome.11-13) Baseline Q waves 14,15) in STEMI patients treated with primary PCI have also been reported to be an independent prognostic marker of clinical outcome.Although the peak serum level of creatinine phosphokinase, 16) myocardial thallium scan, 17) and the evaluation of LV function using transthoracic echocardiography 18) are all useful t...

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Prognostic Value of R-Wave Voltage in Patients With Anterior Wall ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

et al. 2010

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“…Localization of infarction was defined according to criteria of Lipman Table 5 relates the duration of bundle branch block to mortality and development of complete A-V block. Patients with bundle branch block of short duration (1)(2)(3)(4)(5)(6) hours) had a better prognosis (P < 0.0002) than those with bundle branch block which lasted longer than six hours. Development of complete A-V block was not observed in the short duration group.…”

Section: Methodsmentioning

confidence: 97%

Factors Influencing Prognosis of Bundle Branch Block Complicating Acute Antero-Septal Infarction

et al. 1974

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SUMMARYOf 50 consecutive patients with bundle branch block (BBB) complicating acute antero-septal infarction, 37 died in hospital. Patients W HEN BUNDLE BRANCH BLOCK complicates acute myocardial infarction, the site of infarction is usually antero-septal.'-6 The high mortality rate in these cases is considered to be due to extensive myocardial damage rather than to the conduction disorder itself.5 The true prognosis of bundle branch block complicating antero-septal infarction is difficult to establish, however, since in 40-83% of reported cases'-6 bundle branch block was already present on admission and may have reflected pre-existent lesions in the conduction system. The purpose of our study was to determine the incidence and prognosis of patients presenting with acute antero-septal infarction in whom bundle branch block could be considered a consequence of their infarctions. In these patients we evaluated the type, time of onset, and duration of bundle branch block and the P-R and H-V intervals in relation to mortality and development of complete A-V block. Material and MethodsSix hundred and forty patients admitted consecutively to the Coronary Care Unit because of acute myocardial infarction from February 1972 to January 1974 were evaluated. The diagnosis of acute myocardial infarction was based on a typical history of chest pain correlated with the appearance of diagnostic Q waves and characteristic serial changes in serum enzymes. Continuous electrocardiographic monitoring was performed in all patients. A 14-lead electrocardiogram was obtained at least six times a day during the first two days and twice a day thereafter.In several patients the electrocardiographic data were stored on magnetic tape.

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“…[1][2][3][4][5][6][7] To facilitate the optimal use of prophylactic temporary pacing, it is necessary to identify those parameters which determine the risk of development of sudden advanced AV block.…”

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confidence: 99%

The clinical significance of bundle branch block complicating acute myocardial infarction. 2. Indications for temporary and permanent pacemaker insertion.

et al. 1978

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SUMMARY The indication for prophylactic temporary and permanent pacing during acute myocardial infarction (MI) complicated by bundle branch block is high risk of progression via a Type II pattern to second or third degree (high degree) AV block during hospitalization or follow-up. In this study, determinants of high degree AV block during hospitalization and sudden death or recurrent high degree block during the first year of follow-up were examined in 432 patients with Ml and bundle branch block.Timing of onset of bundle branch block, the involved fascicles, and the PR interval were examined as determinants of risk of progression to high degree AV block during MI. At highest risk were 186 patients with blocks involving the right bundle and at least one fascicle of the left bundle which were not documented on prior electrocardiograms. Risk was similar with (38%) or without (31%) accompanying first degree AV block.Patients with transient high degree AV block during MI had a 28% incidence of sudden death or recurrent high degree block during the first year of follow-up. Patients not continuously paced had a higher incidence of sudden death or recurrent high degree block than patients continuously paced (65% vs 10%, P < 0.001). Sudden death during follow-up also occurred in 13% of patients without high degree block during MI. A subgroup with 1) documented prior MI, 2) anterior or indeterminant acute MI, and 3) no symptoms of cardiac failure had a 35% risk of sudden death. The role of permanent pacing in this group is unknown.Thus, patients at high risk of high degree AV block should receive prophylactic temporary pacing. Patients who survive high degree block with MI should receive temporary and then permanent pacing. Patients without high degree AV block during MI who nevertheless have a high risk of sudden death may benefit from permanent pacing.WHEN BUNDLE BRANCH BLOCK complicates acute myocardial infarction, both hospital mortality and the risk of sudden high degree atrioventricular (AV) block are increased. [1][2][3][4][5][6][7] To facilitate the optimal use of prophylactic temporary pacing, it is necessary to identify those parameters which determine the risk of development of sudden advanced AV block.Late sudden death has long been recognized as a major problem in patients surviving acute infarction.18 In addition to the risk of ventricular fibrillation, patients with bundle branch block during myocardial infarction may be at risk of dying suddenly as a result of complete heart block. This latter mechanism has been postulated as an explana-

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Complete Bundle-Branch Block Complicating Acute Myocardial Infarction

Cited by 141 publications

References 9 publications

Prognostic Value of R-Wave Voltage in Patients With Anterior Wall ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Prognostic Value of R-Wave Voltage in Patients With Anterior Wall ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Factors Influencing Prognosis of Bundle Branch Block Complicating Acute Antero-Septal Infarction

The clinical significance of bundle branch block complicating acute myocardial infarction. 2. Indications for temporary and permanent pacemaker insertion.

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