Left Bundle Branch Block in Acute Cardiac Events

Abstract

Between 1991 and 2013, we evaluated the demographics, presentations, and final diagnosis of patients hospitalized with acute cardiac events and left bundle branch block (LBBB). Of 50 992 patients, 768 (1.5%) had LBBB. Compared with non-LBBB patients, patients with LBBB were mostly older, female, diabetic, and had hypertension and chronic kidney failure (CKF; P < .001 for all). Dyspnea (P < .001) and dizziness (P = .037) were more frequent in patients with LBBB. The most frequent cause of admission with LBBB was congestive heart failure (CHF; 54.2%), followed by ST-elevation myocardial infarction (STEMI; 13.3%), valvular heart disease (9.4%), unstable angina (8.3%) and Non-STEMI (7.7%). On multivariate analysis, CKF (odds ratio [OR]: 2.02, 95% confidence interval [CI]: 1.09-3.70) and LBBB (OR: 2.96, 95% CI: 2.01-4.42) were predictors of in-hospital mortality in the entire study population. Further analysis of patients with LBBB showed that CKF (OR: 2.93, 95% CI: 1.40-6.12) was the only predictor of in-hospital mortality. Regardless the presenting symptoms, CHF was the final diagnosis in most cases with LBBB.

Episodic Left Bundle Branch Block—A Comprehensive Review of the Literature

“…The first case of transient BBB was reported by Sir Thomas Lewis in 1913 while its relation to structural heart disease was clearly established in 1938 . Although it has been proposed that symptomatic patients with new or presumably new left bundle branch block (LBBB) and anginal pain should be treated as STEMI equivalents, in a recent registry the proportion of myocardial infarction was significantly lower among patients with LBBB (21%) compared to those without LBBB (32%) . Apart from coronary artery disease (CAD), other causes of LBBB include valve disease, dilated cardiomyopathy, infiltrative cardiomyopathy, hypertensive cardiomyopathy, congenital heart disease, degenerative conduction heart disease (Lenegre and Lev diseases), myocarditis, infective endocarditis, heart trauma/surgery, hyperkalemia, myxedema, and systemic sclerosis .…”

Decision tree model for predicting in‐hospital cardiac arrest among patients admitted with acute coronary syndrome

“…Bansilal et al and Liakopoulos et al reported that left bundle branch block is a major risk factor for both long‐term and short‐term prognosis of cardiovascular disease. Alkindi et al conducted a 23‐year follow‐up, from 1991 to 2013, of 768 patients with left bundle branch block. Their results show that left bundle branch block was an independent risk factor for in‐hospital death, with an OR of 2.96.…”

The Significance of New Left Bundle Branch Block Complicating Acute Myocardial Infarction

“…LBBB was defined as a QRS duration greater than 120 ms in the presence of a sinus or supraventricular rhythm, a QS or rS complex in lead V1, R wave peak time of more than 60 ms with the absence of Q waves in leads I, V5 or V6. The ECGs were analyzed using the Sgarbossa Criteria for STEMI in the presence of LBBB, defined as the presence of one of the following criteria: ≥ 1 millimeter concordant ST elevation; ≥1 mm ST depression in V1, V2, or V3; or the ratio of the ST segment to the S wave being > 25% [4].…”

“…To limit the adverse consequences of this disease, it is required a complex approach in the management of these patients, including aggressive strategies for prevention and early diagnosis [4].…”