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Chronic right bundle branch block and left posterior hemiblock. Clinical, electrophysiologic and prognostic
Insights
Patients with combined right bundle branch block and left posterior hemiblock often have benign outcomes. Prophylactic pacemaker insertion is not routinely indicated for this condition.
Area of Science:
- Cardiology
- Electrophysiology
- Internal Medicine
Background:
- Right bundle branch block (RBBB) and left posterior hemiblock (LPH) can indicate broader conduction system disease.
- Understanding the long-term prognosis of combined RBBB and LPH is crucial for patient management.
Purpose of the Study:
- To electrophysiologically assess patients with chronic RBBB and LPH.
- To prospectively follow these patients to determine clinical outcomes and the need for pacemakers.
Main Methods:
- Electrophysiologic studies were performed on 21 patients with RBBB and LPH.
- Patients were followed prospectively for a mean of 671 days.
Main Results:
- Most patients had hypertensive cardiovascular disease or primary conduction disease.
- Prolonged H-V intervals were observed in 29% of patients.
- Only 14% required pacemakers due to symptomatic conduction disease; one patient died suddenly.
Conclusions:
- Combined RBBB and LPH is associated with less extensive trifascicular disease than previously suggested.
- The clinical course is often benign, with a low incidence of sudden death.
- Prophylactic pacemaker implantation is not routinely recommended for these patients based on short-term data.
Abstract:
Twenty-one patients with long-term right bundle branch block and left posterior himiblock were studied electrophysiologically and then followed up prospectively. The group consisted of 19 men and 2 woman aged 61 +/- 2.7 years (mean +/- standard error of the mean). The majority of patients had either hypertensive cardiovascular disease (48 percent) or primary conduction disease (33 percent). Initial electrophysiologic studies revealed A-H intervals of 58 to 152 msec (mean 98 +/- 7.7) and H-V intervals of 40 to 80 msec (mean 52 +/- 2.1). Six patients (29 percent) had prolonged H-V intervals. The follow-up period ranged from 91 to 1,231 days (mean 671 +/-68). Three of 21 patients (14 percent) needed a permanent pacemaker after development of the following symptomatic conduction disease: sinoatrial block on day 3 of follow-up; second degree atrioventricular (A-V) block, site undetermined, on day 118; and second degree A-V block proximal to the His bundle on day 398. One patient died suddenly (on day 571), and two others died of noncardiac causes. In conclusion, combined right bundle branch block and left posterior hemiblock was associated with less trifascicular disease than reported previously. The clinical course of most of the patients was benign and the incidence of sudden death was relatively small. Symptomatic conduction disease occurred but could be definitely related to trifascicular disease in only one patient. These short-term data suggest that prophylactic pacemaker insertion is not routinely indicated in patients with chronic right bundle branch block and left posterior hemiblock.