Frequency of Left Bundle Branch Block in Patients with Acute Myocardial Infarction; A Cross-Sectional Study
DOI:
https://doi.org/10.31661/gmj.v8i.1576Keywords:
 Myocardial Infarction, Acute Myocardial Infarction, LBBB, RBBBAbstract
Background: Cardiovascular disease (CVDs) is important problems in both developing and developed countries. Currently, non-invasive methods for diagnosis of CVD, especially myocardial infarction (MI), is an interesting subject in the cardiology field. Some evidence showed left bundle branch block (LBBB) is more prevalent among patients with MI. Hence, this study aimed to investigate the frequency of LBBB and their contributing factors in patients with MI. Materials and Methods: In this cross-sectional study, 150 patients with ST elevation or non-ST elevation on their admission electrocardiography who referred to Boo-Ali and Amir-Al-Momenin hospitals, Tehran from January 2016 to June 2017 entered the study. Frequency of LBBB and right bundle branch block (RBBB) in participants and the contributing factors were determined. Results: In this study, of 150 cases (mean age: 60.35±12.88 years), 109 (72.7%) were male, and 41 (27.3%) were female. Out of 150 cases, 12 (8%) had LBBB, 5 (3.3%) RBBB, and 133 (89.7%) had not RBBB or LBBB. Contributing factors were family history, hypertension, and history of ischemic heart disease (P<0.05). Conclusion: Eight percent of patients with myocardial infarction would develop LBBB, which is related to hypertension, and self and family history of ischemic heart disease. [GMJ.2019;8:e1576]Â
References
Al-Daydamony MM, Mustafa TM. The relation between coronary artery disease severity and fragmented QRS complex in patients with left bundle branch block. Egypt Heart J. 2017;69(2):119-26.
https://doi.org/10.1016/j.ehj.2016.09.003
PMid:29622965 PMCid:PMC5839355
Eriksson P, Wilhelmsen L, Rosengren A. Bundle-branch block in middle-aged men: risk of complications and death over 28 years: The Primary Prevention Study in Goteborg, Sweden. Eur Heart J. 2005;26(21):2300-6.
https://doi.org/10.1093/eurheartj/ehi580
PMid:16214833
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. JACC. 1987;10(1):73-80.
https://doi.org/10.1016/S0735-1097(87)80162-6
Biagini E, Shaw LJ, Poldermans D, Schinkel AF, Rizzello V, Elhendy A et al. Accuracy of non-invasive techniques for diagnosis of coronary artery disease and prediction of cardiac events in patients with left bundle branch block: a meta-analysis. Eur J Nucl Med Mol Imaging. 2006;33(12):1442-51.
https://doi.org/10.1007/s00259-006-0156-9
PMid:16847655
Erne P, Iglesias JF, Urban P, Eberli FR, Rickli H, Simon R, et al. Left bundle-branch block in patients with acute myocardial infarction: Presentation, treatment, and trends in outcome from 1997 to 2016 in routine clinical practice. Am Heart J. 2017;184:106-13.
https://doi.org/10.1016/j.ahj.2016.11.003
PMid:28224924
Hiss RG, Lamb LE. Electrocardiographic findings in 122,043 individuals. Circulation. 1962;25(6):947-61.
https://doi.org/10.1161/01.CIR.25.6.947
PMid:13907778
Shaffer AB, Reiser I. Right bundle branch system block in healthy young people. Am Heart J. 1961;62(4):487-93.
https://doi.org/10.1016/0002-8703(61)90257-5
Friedberg C. Disturbances in conduction: heart block and bundle branch block. Diseases of the Heart Philadelphia, PA: WB Saunders Company. 1966:583-639.
Steg PG, James SK, Atar D, Badano LP, Lundqvist CB, Borger MA et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur heart J. 2012;33(20):2569-619.
Jain S, Ting HT, Bell M, Bjerke CM, Lennon RJ, Gersh BJ, et al. Utility of left bundle branch block as a diagnostic criterion for acute myocardial infarction. Ame J cardiol. 2011;107(8):1111-6.
https://doi.org/10.1016/j.amjcard.2010.12.007
PMid:21296327
Lopes RD, Siha H, Fu Y, Mehta RH, Patel MR, Armstrong PW, et al. Diagnosing acute myocardial infarction in patients with left bundle branch block. Ame J cardiol. 2011;108(6):782-8.
https://doi.org/10.1016/j.amjcard.2011.05.006
PMid:21726838
Larson DM, Menssen KM, Sharkey SW, Duval S, Schwartz RS, Harris J, et al. "False-positive" cardiac catheterization laboratory activation among patients with suspected ST-segment elevation myocardial infarction. JAMA. 2007;298(23):2754-60.
https://doi.org/10.1001/jama.298.23.2754
PMid:18165668
Sgarbossa EB, Pinski SL, Barbagelata A, Underwood DA, Gates KB, Topol EJ, et al. Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block. NEJM. 1996;334(8):481-7.
https://doi.org/10.1056/NEJM199602223340801
PMid:8559200
Al-Faleh H, Fu Y, Wagner G, Goodman S, Sgarbossa E, Granger C, et al. Unraveling the spectrum of left bundle branch block in acute myocardial infarction: insights from the Assessment of the Safety and Efficacy of a New Thrombolytic (ASSENT 2 and 3) trials. Ame heart J. 2006;151(1):10-5.
https://doi.org/10.1016/j.ahj.2005.02.043
PMid:16368285
Sgarbossa EB, Pinski SL, Topol EJ, Califf RM, Barbagelata A, Goodman SG, et al. Acute myocardial infarction and complete bundle branch block at hospital admission: clinical characteristics and outcome in the thrombolytic era. JACC. 1998;31(1):105-10.
https://doi.org/10.1016/S0735-1097(97)00446-4
Kontos MC, McQueen RH, Jesse RL, Tatum JL, Ornato JP. Can myocardial infarction be rapidly identified in emergency department patients who have left bundle-branch block? Ann Emerg Med. 2001;37(5):431-8.
https://doi.org/10.1067/mem.2001.114900
PMid:11326177
Go AS, Barron HV, Rundle AC, Ornato JP, Avins AL. Bundle-branch block and in-hospital mortality in acute myocardial infarction. Ann inte Med. 1998;129(9):690-7.
https://doi.org/10.7326/0003-4819-129-9-199811010-00003
PMid:9841600
Hindman MC, Wagner GS, JaRo M, Atkins JM, Scheinman MM, Desanctis RW et al. The clinical significance of bundle branch block complicating acute myocardial infarction. 1. Clinical characteristics, hospital mortality, and one-year follow-up. Circulation. 1978;58(4):679-88.
https://doi.org/10.1161/01.CIR.58.4.679
PMid:688579
Wegmann C, Pfister R, Scholz S, Markhof A, Wanke S, Kuhr K, et al. Diagnostic value of left bundle branch block in patients with acute myocardial infarction. A prospective analysis. Herz. 2015;40(8):1107-14.
https://doi.org/10.1007/s00059-015-4326-z
PMid:26159450
Neeland IJ, Kontos MC, De Lemos JA. Evolving considerations in the management of patients with left bundle branch block and suspected myocardial infarction. JACC. 2012;60(2):96-105.
https://doi.org/10.1016/j.jacc.2012.02.054
PMid:22766335 PMCid:PMC3402162
Melgarejo-Moreno A, Galcerá-Tomás J, Consuegra-Sánchez L, Alonso-Fernández N, DÃaz-Pastor Ã, Escudero-GarcÃa G et al. Relation of new permanent right or left bundle branch block on short-and long-term mortality in acute myocardial infarction bundle branch block and myocardial infarction. The Ame J cardiol. 2015;116(7):1003-9.
https://doi.org/10.1016/j.amjcard.2015.07.019
PMid:26253998
Stenestrand U, Lindbäck J, Wallentin L. Long-term outcome of primary percutaneous coronary intervention vs prehospital and in-hospital thrombolysis for patients with ST-elevation myocardial infarction. JAMA. 2006;296(14):1749-56.
https://doi.org/10.1001/jama.296.14.1749
PMid:17032988
Cai Q, Mehta N, Sgarbossa EB, Pinski SL, Wagner GS, Califf RM, et al. The left bundle-branch block puzzle in the 2013 ST-elevation myocardial infarction guideline: from falsely declaring emergency to denying reperfusion in a high-risk population. Are the Sgarbossa Criteria ready for prime time? Ame heart J. 2013;166(3):409-13.
https://doi.org/10.1016/j.ahj.2013.03.032
PMid:24016487
Liakopoulos V, Kellerth T, Christensen K. Left bundle branch block and suspected myocardial infarction: does chronicity of the branch block matter? Eur Heart J: Acute Cardiovascular Care. 2013;2(2):182-9.
https://doi.org/10.1177/2048872613483589
PMid:24222829 PMCid:PMC3821807
Jain S, Ting HT, Bell M, Bjerke CM, Lennon RJ, Gersh BJ, et al. Utility of left bundle branch block as a diagnostic criterion for acute myocardial infarction. Ame J Cardiol. 2011;107(8):1111-6.
https://doi.org/10.1016/j.amjcard.2010.12.007
PMid:21296327
Lopes RD, Siha H, Fu Y, Mehta RH, Patel MR, Armstrong PW, et al. Diagnosing acute myocardial infarction in patients with left bundle branch block. Ame J Cardiol. 2011;108(6):782-8.
https://doi.org/10.1016/j.amjcard.2011.05.006
PMid:21726838
Erne P, Iglesias JF, Urban P, Eberli FR, Rickli H, Simon R, Fischer TA, Radovanovic D. Left bundle-branch block in patients with acute myocardial infarction: Presentation, treatment, and trends in outcome from 1997 to 2016 in routine clinical practice. Ame heart J. 2017 Feb 1;184:106-13.
https://doi.org/10.1016/j.ahj.2016.11.003
PMid:28224924
Trialists FT. Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. lancet. 1994;343(8893):311-22.
https://doi.org/10.1016/S0140-6736(94)91161-4
Li SF, Walden PL, Marcilla O, Gallagher EJ. Electrocardiographic diagnosis of myocardial infarction in patients with left bundle branch block. Ann Emerg Med. 2000;36(6):561-5.
https://doi.org/10.1067/mem.2000.108079
PMid:11097695
Yeo KK, Li S, Amsterdam EA, Wang TY, Bhatt DL, Saucedo JF, et al. Comparison of clinical characteristics, treatments and outcomes of patients with ST-elevation acute myocardial infarction with versus without new or presumed new left bundle branch block (from NCDR®). The Ame J cardiol. 2012;109(4):497-501.
https://doi.org/10.1016/j.amjcard.2011.09.040
PMid:22152973
Additional Files
Published
How to Cite
Issue
Section
License
Copyright (c) 2019 Galen Medical Journal
This work is licensed under a Creative Commons Attribution 4.0 International License.