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Bundle branch block after myocardial infarction--a long term follow-up
Australian and New Zealand Journal of Medicine
|August 1, 1979
Summary
Patients with left bundle branch block (LBBB) after myocardial infarction face significantly higher mortality within five years compared to those with right bundle branch block (RBBB). Isolated RBBB showed a better prognosis than previously thought.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Bundle branch block (BBB) is a significant complication of myocardial infarction (MI).
- Long-term survival data for MI patients with BBB requires further elucidation.
Purpose of the Study:
- To compare the long-term prognosis of patients with myocardial infarction complicated by right bundle branch block (RBBB) versus left bundle branch block (LBBB).
- To evaluate the impact of additional hemiblock on prognosis in RBBB patients.
Main Methods:
- Actuarial survival analysis of 52 patients with MI and BBB (27 RBBB, 25 LBBB) surviving hospitalization (1967-1972) with follow-up to December 1976.
- Comparison of mortality rates between RBBB and LBBB groups, and analysis of RBBB patients with and without hemiblock.
Main Results:
- Higher 5-year mortality for LBBB (68%) compared to RBBB (33%) (P < 0.05).
- All deaths occurred within the first four years post-MI.
- In RBBB patients, coexisting hemiblock did not worsen prognosis (14% mortality) compared to isolated RBBB (40% mortality).
Conclusions:
- Left bundle branch block is associated with a worse long-term prognosis after myocardial infarction than right bundle branch block.
- Isolated right bundle branch block may have a better prognosis than previously suggested.
- Recommended management includes antiarrhythmic prophylaxis, aneurysmectomy, and early infarct size reduction strategies.