Right bundle brunch block in patients with acute myocardial infarction is associated with a higher in-hospital arrhythmic risk and mortality, and a worse prognosis after discharge

Farinha, J; Parreira, Leonor; Marinheiro, Rita; Fonseca, Marta; Sá, Catarina; Duarte, Tatiana; Esteves, Alina; Mesquita, Dinis; Gonçalves, Sara; Caria, Rui

doi:10.1016/j.jelectrocard.2020.11.007

Cited by 5 publications

(5 citation statements)

References 31 publications

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“…In the simulation study [63], we showed that changed electrical properties of the myocardium, namely, the transmural conduction slowing in anteroseptal or posterior locations, resp., resulted in QRS complex changes suggestive of fascicular blocks (anterior and posterior, resp.). Tis assumption can be supported by the results of the clinical studies [74][75][76].…”

Section: Computer Simulations: the Effect Of The Regional And Diffuse...mentioning

confidence: 77%

“…In these patients, the sequence of ventricular activation differs as compared to patients with the LBBB pattern [ 67 , 73 , 74 ]: the ventricular activation reaches the posterior and lateral walls before the anterior septum and anterior wall are activated, as opposed to patients with LBBB patterns, where the last activated regions are the inferoposterior and lateral walls. This clinical condition is associated with a higher in-hospital arrhythmic risk and mortality and a worse prognosis after discharge [ 67 , 73 , 75 ]. These findings further emphasize the importance of understanding the interrelationship of structural damage to the myocardium, activation sequence, and resultant QRS patterns.…”

Section: Computer Simulations: the Effect Of The Regional And Diffuse...mentioning

confidence: 99%

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The Primary Alteration of Ventricular Myocardium Conduction: The Significant Determinant of Left Bundle Branch Block Pattern

Bachárová

Bayés-de-Luna

2022

Cardiology Research and Practice

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Intraventricular conduction disturbances (IVCD) are currently generally accepted as ECG diagnostic categories. They are characterized by defined QRS complex patterns that reflect the abnormalities in the intraventricular sequence of activation that can be caused by pathology in the His-Purkinje conduction system (HP) or ventricular myocardium. However, the current understanding of the IVCD’s underlying mechanism is mostly attributed to HP structural or functional alterations. The involvement of the working ventricular myocardium is only marginally mentioned or not considered. This opinion paper is focused on the alterations of the ventricular working myocardium leading to the most frequent IVCD pattern—the left bundle branch block pattern (LBBB). Recognizing the underlying mechanisms of the LBBB patterns and the involvement of the ventricular working myocardium is of utmost clinical importance, considering a patient’s prognosis and indication for cardiac resynchronization therapy.

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Section: Computer Simulations: the Effect Of The Regional And Diffuse...mentioning

confidence: 77%

Section: Computer Simulations: the Effect Of The Regional And Diffuse...mentioning

confidence: 99%

The Primary Alteration of Ventricular Myocardium Conduction: The Significant Determinant of Left Bundle Branch Block Pattern

Bachárová

Bayés-de-Luna

2022

Cardiology Research and Practice

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“…Nevertheless, diffuse coronary artery disease in AMI patients with RBBB on the presentation may be an accidental finding rather than the prime cause (Farinha et al 2021;Birnbaum et al 2021).…”

Section: Discussionmentioning

confidence: 96%

“…The one-year survival rate was significantly different in RBBB patients. Furthermore, they had a worse survival rate than LBBB patients, a difference that was statistically significant (Farinha et al 2021;Li et al 2018;Ibanez et al 2018).…”

Section: Discussionmentioning

confidence: 97%

Clinical Impact of Newly Diagnosed Right Bundle Branch Block (RBBB) in ST Segment Elevation Myocardial Infarction (STEMI)

Ramadhan¹,

Suryawan²

2022

IJRP

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A newly diagnosed Right Bundle Branch Block is being investigated as a potential electrographic diagnostic for life-threatening STEMI equivalents (RBBB). RBBB was identified in 7.3 percent of individuals with NSTEMI and 9.1 percent of patients with STEMI. Previously, urgent angiography was suggested for patients with STEMI and Left Bundle Branch Block (LBBB), but it is now recommended for patients with STEMI and Right Bundle Branch Block (RBBB), as it is a poor prognostic sign of a higher mortality in STEMI patients. We report on a 67-year-old woman presented with a chief complaint of continuous heartburn since ten hours before admission to the hospital. Complaints of cold sweating and had comorbidities of diabetes mellitus, hypertension, and ischemic stroke 2 months ago. On arrival, a 12-lead electrocardiogram (ECG) revealed STEMI inferior with RBBB. The cardiac enzyme marker was increased due to an elevated serum troponin-I level of 10 ng/mL (cut off 0,01), an elevated serum creatinine level of 3.7 mg/dL, leukocytosis (13850/L), and compensatory metabolic acidosis. She was treated with aspirin, clopidogrel, statins, ACE-i, and anticoagulants after being diagnosed with inferior STEMI with RBBB. As a practical matter of the COVID19 screening process, the patient did not require primary coronary intervention. The patient developed hemodynamic instability within two hours of being brought to the CVCU. The patient originally presented with transient ventricular tachycardia, which progressed to sustained ventricular tachycardia. Defibrillation with a dosage of 360 joules was used in conjunction with high-quality cardiopulmonary resuscitation until the patient was declared dead.

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“…Changes in QRS duration and pattern usually reflect severe ischemia in ACS, and when ventricular conduction blocks occur, they generally define a high-risk this scenario, although the evidence is inconclusive. Indeed, few studies suggested that patients presenting with bundle branch block (BBB) did not show higher in-hospital mortality [57] (although reflecting high-risk clinical characteristics), whereas in other studies, BBB-and especially right bundle branch block (RBBB)-has been linked with major adverse cardiovascular events (MACEs) during follow-up [58,59]. Particular attention should be paid to the new-onset of a permanent BBB which appeared to be independently associated with a higher 30-day and 7-year all-cause mortality in different reports [60,61].…”

Section: Incidence and Prognosis Of Intraventricular Blocks In The Am...mentioning

confidence: 99%

Atrioventricular and intraventricular blocks in the setting of acute coronary syndromes: a narrative review

Schiavone¹,

Sabato²,

Gobbi³

et al. 2021

Reviews in Cardiovascular Medicine

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Acute coronary syndromes (ACS) might be complicated by atrioventricular (AV) and intraventricular (IV) blocks in a significant number of cases, and often represent a diagnostic and a therapeutic challenge. These conduction disturbances are predictors of adverse prognosis, with complete AV blocks presenting the most severe outcomes, showing an increased in-hospital mortality. With the advent of emergency percutaneous coronary intervention (PCI) and the end of the thrombolysis era, the incidence of both AV and IV blocks has surely decreased, but their prognosis in this setting still remains a matter of debate. The aim of this review is to evaluate the current knowledge on AV and IV blocks in the AMI setting with or without ST segment elevation.

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Right bundle brunch block in patients with acute myocardial infarction is associated with a higher in-hospital arrhythmic risk and mortality, and a worse prognosis after discharge

Cited by 5 publications

References 31 publications

The Primary Alteration of Ventricular Myocardium Conduction: The Significant Determinant of Left Bundle Branch Block Pattern

The Primary Alteration of Ventricular Myocardium Conduction: The Significant Determinant of Left Bundle Branch Block Pattern

Clinical Impact of Newly Diagnosed Right Bundle Branch Block (RBBB) in ST Segment Elevation Myocardial Infarction (STEMI)

Atrioventricular and intraventricular blocks in the setting of acute coronary syndromes: a narrative review

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