Influence of Right and Left Bundle Branch Block in Patients With Cardiogenic Shock and Cardiac Arrest
Jonas Rusnak1, Tobias Schupp1, Kathrin Weidner1
1Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Insights
Right bundle branch block (RBBB) significantly increases 30-day mortality in cardiogenic shock (CS) patients, unlike left bundle branch block (LBBB). This finding holds true even for CS patients experiencing cardiac arrest.
Area of Science:
- Cardiology
- Intensive Care Medicine
- Electrophysiology
Background:
- Bundle branch blocks (BBB), including right bundle branch block (RBBB) and left bundle branch block (LBBB), are known to influence prognosis in heart failure patients.
- The prognostic significance of RBBB and LBBB specifically in the context of cardiogenic shock (CS) requires further elucidation.
Purpose of the Study:
- To investigate the prognostic impact of RBBB and LBBB on 30-day all-cause mortality in patients with cardiogenic shock (CS).
- To compare the outcomes of CS patients with RBBB, LBBB, and no BBB.
Main Methods:
- A prospective registry study was conducted at the ICU of a tertiary academic hospital in Germany.
- Adult patients diagnosed with CS were included in the study cohort.
- The primary outcome assessed was 30-day all-cause mortality, analyzed using log-rank tests and multivariable Cox regression.
Main Results:
- The study included 248 CS patients. RBBB was associated with the highest 30-day mortality (72.5%), followed by LBBB (52.9%) and no BBB (50.0%).
- These mortality differences persisted in the subgroup of CS patients with cardiac arrest at admission (RBBB 90.0%, LBBB 73.3%, no BBB 62.2%).
- Multivariable analysis confirmed RBBB as an independent negative prognostic factor for 30-day mortality (HR, 1.807), while LBBB showed no significant impact. Lactate, troponin I, and Acute Physiology Score also predicted mortality.
Conclusions:
- Right bundle branch block (RBBB) is independently associated with increased 30-day all-cause mortality in patients with cardiogenic shock (CS), irrespective of cardiac arrest status.
- Left bundle branch block (LBBB) did not demonstrate a significant prognostic impact on 30-day mortality in this CS cohort.
- Factors such as Acute Physiology Score, lactate, and troponin levels are also critical predictors of mortality in CS patients.
Objectives:
The study investigates the prognostic impact of right bundle branch block (RBBB) and left bundle branch block (LBBB) in patients with cardiogenic shock (CS) compared with no bundle branch block (BBB). In patients with heart failure, existence of RBBB and LBBB has influence on prognosis.
Design:
Prospective registry-study.
Setting:
ICU of a tertiary academic hospital in Germany.
Patients:
Adult patients with CS.
Interventions:
None.
Measurements And Main Results:
Consecutive patients with CS were included. The prognostic impact of RBBB and LBBB on 30-day all-cause mortality was tested within the entire cohort and in the subgroup of CS patients with cardiac arrest at admission. The final study cohort comprised 248 patients. Patients with RBBB showed the highest 30-day all-cause mortality followed by LBBB and no BBB (72.5% vs. 52.9% vs. 50.0%; log-rank p = 0.015). These findings were consistent even after solely including CS patients with cardiac arrest (90.0% vs. 73.3% vs. 62.2%; log-rank p = 0.008). After adjustment for lactate, norepinephrine, troponin I, Acute Physiology Score, Society of Cardiovascular Angiography & Interventions shock stage, and heart rate in a multivariable Cox regression analysis, RBBB still revealed a negative impact on 30-day all-cause mortality (hazard ratio [HR], 1.807; 95% CI, 1.107-2.947; p = 0.018), whereas LBBB was not associated with 30-day all-cause mortality. In this multivariable Cox regression model lactate (HR, 1.065; 95% CI, 1.018-1.115; p = 0.006), troponin I (HR, 1.003; 95% CI, 1.001-1.005; p = 0.001), and Acute Physiology Score (HR, 1.033; 95% CI, 1.001-1.066; p = 0.041) were as well associated with 30-day all-cause mortality. Finally, no association of RBBB was found with the incidence of liver or severe renal failure.
Conclusions:
Besides the Acute Physiology Score, lactate, and troponin levels, RBBB was associated with an increased 30-day all-cause mortality in consecutive CS patients with and without cardiac arrest, whereas LBBB showed no prognostic impact.
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