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

• Published in: Journal of electrocardiology 2021-01, Vol.64, p.3-8
• Main Authors: Farinha, José Maria, Parreira, Leonor, Marinheiro, Rita, Fonseca, Marta, Sá, Catarina, Duarte, Tatiana, Esteves, Ana, Mesquita, Dinis, Gonçalves, Sara, Caria, Rui
• Format: Article
• Language: English
• Subjects: Acute myocardial infarction; Cardiac arrhythmia; Heart attacks; Major adverse cardiovascular events; Medical imaging; Mortality; Prognosis; Right bundle brunch block; Ultrasonic imaging; Ventricular arrhythmias
• ISSN: 0022-0736; 1532-8430
• DOI: 10.1016/j.jelectrocard.2020.11.007

Recently, the presence of right bundle brunch block (RBBB) in patients with persistent ischaemic symptoms has been suggested as an indication for emergent coronary angiography. The aim of this study was to assess the prognostic impact of RBBB in patients with acute myocardial infarction (AMI) before the implementation of the recent recommendations. We retrospectively studied consecutive patients admitted with AMI between 2011 and 2013. Patients with left bundle brunch block, pacemaker, or nonspecific intraventricular conduction delay were excluded. Patients with RBBB were compared with those without RBBB. Clinical characteristics, in-hospital evolution, and major adverse cardiovascular events (MACE) during follow-up, defined as cardiovascular death, sustained ventricular arrhythmias, acute heart failure syndromes, recurrent myocardial infarction, or acute stroke, were analysed. The analysis included 481 patients. Thirty two patients (6.7%) had RBBB. Patients with RBBB were older. During hospital admission, RBBB patients had a higher rate of sustained ventricular tachycardia and death. Survival curve analysis showed that patients with RBBB had a lower in-hospital survival rate (Log-rank, p = 0.004). After discharge, during a mean follow-up time of 24.3 ± 11.6 months, 53 patients (12%) died. Survival curve analysis showed a lower survival rate free of MACE for those patients with RBBB (Log-rank, p = 0.011). RBBB was independently associated with MACE occurrence (HR 2.17, 95% CI 1.07–4.43; p = 0.033), after adjusting for demographic data, coronary angiography findings, treatment performed, echocardiographic evaluation, and medical therapy. Patients with RBBB had a higher rate of in-hospital mortality and arrhythmic events, and an increased risk of MACE during follow-up. •Most recent ESC STEMI guidelines describe RBBB as a high-risk feature in patients with suspected myocardial infarction.•AMI patients with RBBB had a higher rate of in-hospital death and arrhythmic events.•AMI patients with RBBB had an increased risk of MACE during follow-up.•More than half of AMI patients with RBBB presented with at least one completely occluded coronary artery, mostly the LAD.•There is probably an indication for emergent coronary angiography for patients with RBBB and ischemic symptoms.•After discharge, these patients could eventually benefit from a closer monitoring and a longer follow-up.