Clinical Presentations and Outcomes in Patients Presenting With Acute Cardiac Events and Right Bundle Branch Block

We conducted a retrospective analysis of 50 974 patients admitted with acute cardiac events with and without right bundle branch block (RBBB) over 23 years. Compared to non-RBBB, patients with RBBB (n = 386; 0.8%) were 3 years older (P = .001), more likely to present with breathlessness rather than...

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Bibliographic Details
Published in:Angiology 2020-03, Vol.71 (3), p.256-262
Main Authors: Alkindi, Fahad, El-Menyar, Ayman, Rafie, Ihsan, Arabi, Abdulrahman, Al Suwaidi, Jassim, Singh, Rajvir, Albinali, Hajar, Gehani, Abdurrazzak A.
Format: Article
Language:English
Subjects:
Adult
Aged
Bundle-Branch Block - mortality
Electrocardiography - methods
Female
Heart Failure - complications
Heart Failure - physiopathology
Hospital Mortality
Humans
Male
Middle Aged
Myocardial Infarction - mortality
Retrospective Studies
ST Elevation Myocardial Infarction - complications
ST Elevation Myocardial Infarction - physiopathology
Ventricular Function, Left - physiology
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Summary:We conducted a retrospective analysis of 50 974 patients admitted with acute cardiac events with and without right bundle branch block (RBBB) over 23 years. Compared to non-RBBB, patients with RBBB (n = 386; 0.8%) were 3 years older (P = .001), more likely to present with breathlessness rather than chest pain (P = .001), and had more diabetes mellitus (P = .001). Patients with RBBB had significantly higher cardiac enzymes (P = .001); however, there were no significant differences in the presentation with ST-segment elevation myocardial infarction (24.6% vs 22.2%), non-ST-segment elevation myocardial infarction (23.7% vs 22.4%), and unstable angina (51.7% vs 55.4%). Patients with RBBB were more likely to have congestive heart failure (CHF; 9.6% vs 3.2%, P = .001), cardiogenic shock (10.6% vs 1.7%, P = .001), and ventricular tachyarrhythmias (7.3% vs 2.2%, P = .001). Left ventricular ejection fraction and hospital length of stay were comparable between the groups. All-cause mortality was 5 times greater in patients with RBBB (21% vs 4.2%, P = .001). Right bundle branch block was independent predictor of mortality (adjusted odd ratio 5.14; 95% confidence interval: 3.90-6.70). Subanalysis comparing normal QRS, RBBB, and left BBB showed that RBBB was associated with the worst outcomes except for CHF. Although RBBB presents in only about 1% of patients with cardiac disease, it was found to be an independent predictor of hospital mortality.
ISSN:0003-3197
1940-1574
DOI:10.1177/0003319719892159