Right Bundle Branch Block Is not a Predictor of Coronary Artery Disease
Right bundle branch block (RBBB) is considered as an important predictor of poor outcome in patients with acute myocardial infarction, but the prognostic implication of RBBB in patients with suspected coronary artery disease (CAD) is unclear. Furthermore, the association between RBBB and incidence of CAD also its influence on the severity of stenosis in coronary arteries has not been established. This study was designed to assess the relationship between RBBB and the presence and the severity of CAD in patients with suspected CAD. The study population consisted of 172 patients with RBBB and 174 patients with normal resting electrocardiography (ECG). Severity of CAD was defined as estimated Gensini score according to the degree, quantity and distribution of lesions in angiographic study. According to our study based on angiographic investigations, in patients with RBBB the prevalence of CAD was 77.3 percent versus 70.1 percent in patients with normal resting ECG (P=0.13). Also, there was no significant association between the presence of RBBB and magnitude of Gensini score (OR=0.87, P=0.62). However, male gender and history of diabetes mellitus were associated with higher Gensini score (OR=3.41; 95% CI: 1.96-5.93, P<0.0001 and OR=3.22; 95% CI: 1.77-5.87, P<0.0001 respectively). This study suggests that although RBBB was associated with more severity of stenosis in left coronary system (LAD&LCX), but as a whole there was no association between RBBB and the presence and severity of CAD.
Widimsky P, Rohác F, Stásek J, Kala P, Rokyta R, Kuzmanov B, Jakl M, Poloczek M, Kanovsky J, Bernat I, Hlinomaz O, Belohlávek J, Král A, Mrázek V, Grigorov V, et al. Primary angioplasty in acute myocardial infarction with right bundle branch block: should new onset right bundle branch block be added to future guidelines as an indication for reperfusion therapy? Eur Heart J 2012;33(1):86-95.
Wong CK. The evolution of reperfusion management in patients with suspected myocardial infarction and bundle branch block: how ECG language will intertwine with angiographic findings. Int J Cardiol 2011;153(3):326-7.
Patanè S, Marte F, Sturiale M. Changing axis deviation and intermittent right bundle branch block during acute myocardial infarction. Int J Cardiol 2011;147(2):e26-8.
Assali A, Sclarovsky S, Herz I, Solodky A, Sulkes J, Strasberg B. Importance of left anterior hemiblock development in inferior wall acute myocardial infarction. Am J Cardiol 1997;79(5):672-4.
Büyüköztürk K, Korkut F, Meric M, Deligönül U, Ozkan E, Ozcan R. Prognostic significance of isolated left anterior hemiblock and left axis deviation in the course of acute myocardial infarction. Br Heart J 1977;39(11):1192-5.
Thygesen K, Haghfelt T, Steinmetz E, Nielsen BL. Longterm survival after myocardial infarction as related to early complications. Eur J Cardiol 1977;6(1):41-51.
Kourtesis P, Lichstein E, Chadda KD, Gupta PK. Incidence and significance of left anterior hemiblock complicating acute inferior wall myocardial infarction. Circulation 1976;53(5):784-7.
Steinmetz E, Haghfelt T, Thygesen K. Incidence and prognostic significance of intraventricular block in acute myocardial infarction. Cardiology1979;64(5):280-8.
Ricou F, Nicod P, Gilpin E, Henning H, Ross J Jr. Influence of right bundle branch block on short- and longterm survival after acute anterior myocardial infarction. J Am Coll Cardiol 1991;17(4):858-63.
Go AS, Barron HV, Rundle AC, Ornato JP, Avins AL. Bundle-branch block and in-hospital mortality in acute myocardial infarction. National Registry of Myocardial Infarction 2 Investigators. Ann Intern Med 1998;129(9):690-7.
Krecki R, Drozdz J, Krzemińska-Pakuła M. Prognostic factors in patients with advanced multi-vessel coronary artery disease. Kardiol Pol 2006;64(11):1179-85; discussion 1186.
Freedman RA, Alderman EL, Sheffield LT, Saporito M, Fisher LD. Bundle branch block in patients with chronic coronary artery disease: angiographic correlates and prognostic significance. J Am Coll Cardiol 1987;10(1):73-80.
Biagini E, Elhendy A, Schinkel AF, Nelwan S, Rizzello V, van Domburg RT, Rapezzi C, Rocchi G, Simoons ML, Bax JJ, Poldermans D. Prognostic significance of left anterior hemiblock in patients with suspected coronary artery disease. J Am Coll Cardiol 2005;46(5):858-63.
Ozeke O, Aras D, Deveci B, Ozlu MF, Gurel OM, Canga A, Kaya V, Guler TE, Yildiz A, Ergun K, Selcuk MT, Topaloglu S, Maden O, Tufekcioglu O. Comparison of presence and extent of coronary narrowing in patients with left bundle branch block without diabetes mellitus to patients with and without left bundle branch block but with diabetes mellitus. Am J Cardiol 2006;97(6):857-9.
Cortigiani L, Bigi R, Gigli G, Coletta C, Mariotti E, Dodi C, Astarita C, Picano E. Prognostic implications of intraventricular conduction defects in patients undergoingstress echocardiography for suspected coronary artery disease. Am J Med 2003;115(1):12-8.
Lévy S, Gérard R, Castellanos A Jr, Gharhamani A, Sommer LS. Pure left anterior hemiblock: hemodynamic and arteriographic aspects in patients with coronary artery disease. Eur J Cardiol 1978;8(4-5):553-63.
Corne RA, Beamish RE, Rollwagen RL. Significance of left anterior hemiblock. Br Heart J 1978;40(5):552-7.
Yano K, Peskoe SM, Rhoads GG, Moore JO, Kagan A. Left axis deviation and left anterior hemiblock among 8,000 Japanese-American men. Am J Cardiol 1975;35(6):809-15.
Ostrander LD Jr. Left axis deviation: prevalence, associated conditions, and prognosis. An epidemiologic study. Ann Intern Med 1971;75(1):23-8.
Lévy S, Gérard R, Castellanos A, Gharhamani AR, Sommer LS. Transient left anterior hemiblock during angina pectoris: coronarographic aspects and clinical significance. Eur J Cardiol 1979;9(3):215-25.
Castellanos A Jr, Lemberg L. Diagnosis of isolated and combined block in the bundle branches and the divisions of the left branch. Circulation 1971;43(6):971-6.
Milliken JA. Isolated and complicated left anterior fascicular block: a review of suggested electrocardiographic criteria. J Electrocardiol 1983;16(2):199-211.
Mahmod M, Karamitsos TD, Suttie JJ, Myerson SG, Neubauer S, Francis JM. Prevalence of cardiomyopathy in asymptomatic patients with left bundle branch block referred for cardiovascular magnetic resonance imaging. Int J Cardiovasc Imaging 2011.
Abrol R, Trost JC, Nguyen K, Cigarroa JE, Murphy SA, McGuire DK, Hillis LD, Keeley EC. Predictors of coronary artery disease in patients with left bundle branch block undergoing coronary angiography. Am J Cardiol 2006;98(10):1307-10.
Duzenli MA, Ozdemir K, Soylu A, Aygul N, Yazici M, Tokac M. The effect of isolated left bundle branch block on the myocardial velocities and myocardial performance index. Echocardiography 2008;25(3):256-63.
Lewis CM, Dagenais GR, Friesinger GC, Ross RS. Coronary arteriographic appearances in patients with left bundle-branch block. Circulation 1970;41(2):299-307.
Haft JI, DeMaio SJ Jr, Bartoszyk OB. Coronary arteriographic findings in symptomatic right bundle branch block. Am J Cardiol 1984;53(6):770-3.
|Issue||Vol 50, No 2 (2012)|
|Right bundle branch block Coronary artery disease Gensini score|
|Rights and permissions|
|This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.|