The clinical significance of bundle branch block complicating acute myocardial infarction. 1. Clinical characteristics, hospital mortality, and one-year follow-up.

Abstract

To provide an understanding of the clinical characteristics of patients with acute myocardial infarction (MI) and bundle branch block, experience from five centers was accumulated. Patients in whom bundle branch block first appeared after the onset of cardiogenic shock were excluded. In 432 patients, the most common types of block were left (38%) and right with left anterior fascicular block (34%). In 42% of the patients, bundle branch block was new. Progression to high degree (second or third degree) atrioventricular (AV) block via a Type II pattern occurred in 22% of the patients. Hospital and first year follow-up mortality rates were 28% and 28%, respectively. Only 46% of the patients developed pulmonary edema or shock (Killip Class III or IV), and hospital mortality was related to the amount of heart failure (8%, 7%, 27%, 83% for Killip Classes I-IV, respectively). Patients with progression to second degree or third degree AV block via a Type II pattern had increased hospital mortality compared with patients without this complication (47% vs 23%, P less than 0.001). In the absence of pulmonary edema or shock, patients with Type II second degree or third degree AV block still had a higher mortality rate than patients without advanced AV block (31% vs 2%, P less than 0.005), with nearly all the deaths due to abrupt development of AV block. Thus, in many patients MI with bundle branch block is associated with severe heart failure. However, this was not true for a majority of the patients, in whom therapy aimed at preventing morbidity and mortality due to the bradyarrhythmia of advanced AV block might be beneficial.

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

“…[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.…”

Left bundle‐branch block—pathophysiology, prognosis, and clinical management

“…In several studies on chronic and acute CAD, LBBB was found to be an excellent predictor of mortality and events [20][21][22][23][24] (Table 2). In 681 patients with acute myocardial infarction (AMI) enrolled in the Thrombolysis and Angioplasty in Myocardial Infarction (TAMI) 9 and Global Utilization of Streptokinase and t-PA for Occluded Arteries (GUSTO) 1 protocols, 25 the incidence of LBBB was found to be 7%.…”

Acute Myocardial Infarction with Bundle Branch Block (Rbbb or Lbbb) - Clinical Characteristics, Complications & Prognostic Significance - A Hospital Based Study

“…2,9,12 Complete BBB, left or right, on electrocardiogram at presentation occurs in a wide range of 8% to 23% of patients with AMI and represents an independent important predictor of in hospital complications and poor survival. [1][2][3][4][5][6][7][8][9][10][11][12][13] New BBB usually expresses a large infarction, frequently accompanied by heart failure, complete AV block, arrhythmia and high mortality rates. 10 In the present study, an attempt has been made to assess clinical characteristics and short term prognostic significance of BBB in acute MI, with respect to its location, time of appearance and association with complications.…”