Clinical Presentations and Outcomes in Patients Presenting With Acute Cardiac Events and Right Bundle Branch Block.
Fahad AlkindiAyman El-MenyarIhsan RafieAbdulrahman ArabiJassim Al SuwaidiRajvir SinghHajar AlbinaliAbdurrazzak A GehaniPublished in: Angiology (2019)
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.
Keyphrases
- left ventricular
- st segment elevation myocardial infarction
- percutaneous coronary intervention
- heart failure
- aortic stenosis
- ejection fraction
- cardiac resynchronization therapy
- acute myocardial infarction
- liver failure
- hypertrophic cardiomyopathy
- coronary artery disease
- healthcare
- mitral valve
- respiratory failure
- acute coronary syndrome
- risk factors
- blood brain barrier
- type diabetes
- case report
- emergency department
- hepatitis b virus
- acute heart failure
- middle aged
- coronary artery
- atrial fibrillation
- acute respiratory distress syndrome
- electronic health record
- insulin resistance
- extracorporeal membrane oxygenation
- mechanical ventilation