To determine the frequency of the left BBB and common clinical outcome associated with it in patients with acute anterior myocardial infarction

Authors

  • Gulshan Ahmad Punjab Institute of Cardiology, Lahore
  • Naresh Kumar Khurana Avacina Medical and Dental College, Lahore - Pakistan
  • Safoora Anjum University College of Medicine & Dentistry (UCMD), Lahore - Pakistan
  • Samar Arfeen Punjab Institute of Cardiology, Lahore
  • Muhammad Afzal Avacina Medical and Dental College, Lahore - Pakistan
  • Zeeshan Hassan University Hospital of North Midlands Trust. 3 Lynam Street Stoke on Trent ST47ED

DOI:

https://doi.org/10.55958/jcvd.v20i2.176

Abstract

Introduction: Coronary Artery disease (CAD) is a health problem that affects global men and women population and presents as the principal cause of mortality in 1st world countries. Heart blocks, such as atrioventricular (AV) nodal blocks (1st, 2nd, and 3rd degree) and intraventricular blocks (right or left bundle branch block), are included in the electrical disturbances of paramount importance which takes place after occurrence of acute myocardial infarction (AMI). In patients where an acute MI is present, bundle branch block (BBB) might point towards acute or a damage that is pre-existent to proximal conducting system or diffusion of damage to ventricular myocardium that leads to delay in the conduction.

Objective: To determine the frequency of the left bundle branch block and its common clinical outcome in the patients suffering from acute anterior myocardial infarction.

Materials and Methods: The current study was carried out in the in the Department of Cardiology, Punjab Institute of Cardiology Lahore Pakistan in the duration of May 04, 2021 to November 03, 2021. Using Descriptive Cross Sectional Study Design, 230 patients of acute myocardial infarction (MI) in total were made part of this study in  consecutive manner ECG and Echocardiography was performed for the detection LBBB and all patients of LBBB were followed up till one month to determine the common clinical outcome.

Results: In current study 230 patients were made part of it, 60.9% males and 39.1% females. Value of mean age for the patients was 52.8 years whereas standard deviation of 7.8 years. LBBB was detected in 18.3% of patients and on follow up cardiogenic shock was seen in 13% of patients, in hospital death in 4.3%- and 30-day mortality in 6.1%.

Conclusion: LBBB is frequent occurrence in our population, and it must be enthusiastically diagnosed and treated to reduce the burden of shock and mortality.

Author Biographies

Naresh Kumar Khurana, Avacina Medical and Dental College, Lahore - Pakistan

Professor of Cardiology

Safoora Anjum, University College of Medicine & Dentistry (UCMD), Lahore - Pakistan

Assistant Professor

Samar Arfeen , Punjab Institute of Cardiology, Lahore

Senior Registrar Cardiology

Muhammad Afzal, Avacina Medical and Dental College, Lahore - Pakistan

Assistant Professor of Cardiology

Zeeshan Hassan, University Hospital of North Midlands Trust. 3 Lynam Street Stoke on Trent ST47ED

Consultant Cardiologist

References

Farre N, Camprubi M, Serrano I, Oliva X, Guarinos J, Fernandez F, et al. Left Bundle Branch Block in Suspected Acute Myocardial Infarction. Circulation 2013;128(22 Supplement):A10949.

Antman EM, Anbe DT, Armstrong PW. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction; A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to revise the 1999 guidelines for the management of ST-elevation myocardial infarction. J Am Coll Cardiol 2004;44:1-211.

Van De WF, Bax J, Betriu A, et al. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J 2008;29:2909-45.

Shlipak MG, Go AS, Frederick PD, et al. Treatment and outcomes of left bundle-branch block patients with myocardial infarction who present without chest pain. J Am Coll Cardiol 2000;36:706-12.

Yeo KK, Li S, Wang TY, et al. New or presumed new left bundle branch block in patients with acute myocardial infarction: findings From ACTION Registry-GWTG. J Am Coll Cardiol 2010;55:A107.

Kontos MC, McQueen MJ, Jesse RL, et al. Can myocardial infarction be rapidly identified in emergency department patients who have left bundle-branch block? Ann Emerg Med 2001;37:431-8.

Li SF, Walden PL, Marcilla O, et al. Electrocardiographic diagnosis of myocardial infarction in patients with left bundle branch block. Ann Emerg Med 2000;36:561-5.

Chang AM, Shofer FS, Tabas JA, et al. Lack of association between left bundle-branch block and acute myocardial infarction in symptomatic ED patients. Am J Emerg Med 2009;27:916-21.

Wong CK, French JK, Aylward PE, et al. Patients with prolonged ischemic chest pain and presumed-new left bundle branch block have heterogeneous outcomes depending on the presence of ST-segment changes. J Am Coll Cardiol 2005;46:29-38.

Al Faleh H, Fu Y, Wagner G, et al. Unraveling the spectrum of left bundle branch block in acute myocardial infarction: insights from the Assessment of the Safety and Efficacy of a New Thrombolytic (ASSENT 2 and 3) trials. Am Heart J 2006;151:10-5.

Brilakis ES, Wright RS, Kopecky SL, Reeder GS, Williams BA, Miller WL. Bundle branch block as a predictor of long-term survival after acute myocardial infarction Am J Cardiol 2001 88 205–209.

Ricou F, Nicod P, Gilpin E, Henning H, Ross JJr. Influence of right bundle branch block on short- and long-term survival after inferior wall Q-wave myocardial infarction Am J Cardiol 1991 67 1143–1146.

Stenestrand U, Tabrizi F, Lindback J, Englund A, Rosenqvist M, Wallentin L. Comorbidity, and myocardial dysfunction are the main explanations for the higher 1-year mortality in acute myocardial infarction with left bundle-branch block Circulation 2004 110 1896–1902

Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, Tavazzi L. The effect of cardiac resynchronization on morbidity and mortality in heart failure N Engl J Med 2005 352 1539–1549.

Dickstein K, Vardas PE, Auricchio A, Daubert JC, Linde C, McMurray J, et al. 2010 focused update of ESC Guidelines on device therapy in heart failure: an update of the 2008 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure and the 2007 ESC Guidelines for cardiac and resynchronization therapy. Developed with the special contribution of the Heart Failure Association and the European Heart Rhythm Association Eur J Heart Fail 2010;12:1143–1153.

Bhali MA, Khan MQ, Samore NA, Mehreen S. Frequency, and clinical outcome in conduction defects in acute myocardial infarction. J Ayub Med Coll Abbottabad 2009;21:32-7.

Khan S, Abrar A, Abid AR, Jan J, Jan T, Khan H. In hospital outcome of patients having acute myocardial infarction with and without streptokinase. Gomal J Med Sci 2009;7:96-100.

Baldasseroni S, Opasich C, Gorini M, Lucci D, Marchionni N, Marini M, et al. Left bundle-branch block is associated with increased 1-year sudden and total mortality rate in 5517 outpatients with congestive heart failure: a report from the Italian Network on Congestive Heart Failure Am Heart J 2002;143:398–405.

Guerrero M, Harjai K, Stone GW, Brodie B, Cox D, Boura J, et al. Comparison of the prognostic effect of left versus right versus no bundle branch block on presenting electrocardiogram in acute myocardial infarction patients treated with primary angioplasty in the primary angioplasty in myocardial infarction trials Am J Cardiol 2005;96:482–488.

Barsheshet A, Shotan A, Cohen E, Garty M, Goldenberg I, Sandach A, et al. Predictors of long-term (4-year) mortality in elderly and young patients with acute heart failure Eur J Heart Fail 2010;12:833–840.

Sgarbossa EB, Pinski SL, Topol EJ, Califf RM, Barbagelata A, Goodman SG, et al. Acute myocardial infarction, and complete bundle branch block at hospital admission: clinical characteristics and outcome in the thrombolytic era. GUSTO-I Investigators. Global Utilization of Streptokinase and t-PA [tissue-type plasminogen activator] for Occluded Coronary Arteries J Am Coll Cardiol 1998;31:105–110.

Licka M, Zimmermann R, Zehelein J, Dengler TJ, Katus HA, Kubler W. Troponin T concentrations 72 hours after myocardial infarction as a serological estimate of infarct size Heart 2002;87:520–524.

Brembilla-Perrot B, Alla F, Suty-Selton C, Huttin O, Blangy H, Sadoul N, et al. Nonischemic dilated cardiomyopathy: results of noninvasive and invasive evaluation in 310 patients and clinical significance of bundle branch block Pacing Clin Electrophysiol 2008;31:1383–1390.

Kleemann T, Juenger C, Gitt AK, Schiele R, Schneider S, Senges J. Incidence, and clinical impact of right bundle branch block in patients with acute myocardial infarction: ST elevation myocardial infarction versus non-ST elevation myocardial infarction Am Heart J 2008;156:256–261.

Wong CK, Gao W, Stewart RA, French JK, Aylward PE, White HD. Relationship of QRS duration at baseline and changes over 60 min after fibrinolysis to 30-day mortality with different locations of ST elevation myocardial infarction: results from the Hirulog and Early Reperfusion or Occlusion-2 trial Heart 2009;95:276–282.

Andersen HR, Nielsen TT, Rasmussen K, Thuesen L, Kelbaek H, Thayssen P, et al, A comparison of coronary angioplasty with fibrinolytic therapy in acute myocardial infarction N Engl J Med 2003;349:733–742.

Published

2025-01-17

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Section

Articles