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Predictive Effect of Atypical Right Bundle-Branch Block on In-Hospital Sudden Cardiac Death and Cardiac Rupture and

Tiangui Yang1, Jie Chen1, Xi Fu1

  • 1Department of Cardiology Shengjing Hospital of China Medical University Shenyang Liaoning China.

Journal of the American Heart Association
|February 26, 2025
PubMed

Insights

Atypical right bundle-branch blocks (ARBBB) predict higher risks of in-hospital sudden cardiac death and cardiac rupture in acute myocardial infarction patients. This finding highlights ARBBB as a crucial indicator for adverse outcomes following percutaneous coronary intervention.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Interventional Cardiology

Background:

  • Atypical right bundle-branch block (ARBBB) is a less understood electrocardiographic finding.
  • Its prognostic significance in acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI) requires further elucidation.
  • Understanding ARBBB's impact on sudden cardiac death (SCD) and cardiac rupture (CR) is critical for patient management.

Purpose of the Study:

  • To investigate the predictive value of ARBBB for in-hospital SCD, CR, and long-term prognosis.
  • To compare outcomes among patients with ARBBB, typical right BBB, left BBB, and no BBB.
  • To assess ARBBB's role in predicting major adverse cardiovascular and cerebrovascular events (MACCE) within two years.

Main Methods:

  • Retrospective study including 13,886 patients with first-episode AMI undergoing drug-eluting stent PCI.
  • Patients were categorized into four groups: ARBBB (n=348), typical right BBB (n=374), left BBB (n=366), and non-BBB (n=12,798).
  • Primary endpoints were in-hospital SCD and CR; secondary endpoint was 2-year MACCE.

Main Results:

  • ARBBB group showed significantly higher incidences of in-hospital SCD (10.6%) and CR (5.7%) compared to other groups (P<0.001).
  • ARBBB was a significant predictor of in-hospital SCD (HR, 2.45) and CR (HR, 3.32).
  • ARBBB also predicted 2-year MACCE (HR, 2.99).

Conclusions:

  • Atypical right bundle-branch block is an independent predictor of in-hospital SCD and CR in AMI patients treated with PCI.
  • ARBBB is associated with an increased risk of adverse cardiovascular events within two years post-PCI.
  • Identification of ARBBB in AMI patients undergoing PCI warrants closer monitoring and risk stratification.
Abstract

Keywords:
MACCEacute myocardial infarctionatypical right bundle‐branch blockcardiac rupturepercutaneous coronary interventionsudden cardiac death

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