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The 'qRBBB myocardial infarction': Unwrapping an old enigma

Charan P Lanjewar1, Bhavik S Shah1, Girish R Sabnis1

  • 1King Edward Memorial Hospital and Seth G.S. Medical College, Mumbai, India.

Indian Heart Journal
|January 10, 2024
PubMed

Insights

Patients with acute anterior-wall ST-elevation myocardial infarction (STEMI) and a right bundle branch block (RBBB) pattern on ECG face higher risks of cardiogenic shock and longer hospital stays, indicating a more severe condition.

Area of Science:

  • Cardiology
  • Electrocardiography
  • Acute Coronary Syndromes

Background:

  • Acute anterior-wall ST-elevation myocardial infarction (STEMI) is a critical cardiovascular event.
  • The presence of a right bundle branch block (RBBB) on electrocardiogram (ECG) in STEMI patients requires further investigation regarding its prognostic implications.

Purpose of the Study:

  • To investigate the clinical characteristics and outcomes of patients with acute anterior-wall STEMI and a qRBBB pattern on ECG.
  • To compare the incidence of adverse events in patients with and without qRBBB in the context of anterior-wall STEMI.

Main Methods:

  • A prospective, observational study conducted at a single tertiary-care center over two years.
  • Inclusion of 1128 patients with acute anterior-wall STEMI, with subgroup analysis of those presenting with a qRBBB pattern (n=100).

Main Results:

  • The qRBBB subgroup (11.28%) showed a significantly increased risk of cardiogenic shock.
  • Patients with qRBBB experienced longer hospital stays, presented with higher Killip class, and had a higher incidence of recanalized IRA.
  • A remarkably depressed left ventricular ejection fraction (LVEF) was significantly associated with the qRBBB pattern in STEMI.

Conclusions:

  • The qRBBB pattern in acute anterior-wall STEMI is associated with adverse outcomes, including cardiogenic shock and reduced LVEF.
  • qRBBB-MI represents a menacing form of acute coronary syndrome (ACS) linked to high mortality and long-term morbidity.
  • Early identification and management strategies for STEMI patients with qRBBB are crucial to mitigate poor prognosis.

Keywords:
Cardiogenic shockST elevation myocardial infarctionqRBBB pattern

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