Development Of Right Bundle Branch Block Research Articles

Ventricular conduction defects after transcatheter aortic valve implantation: a single-institute analysis.

Patients with aortic stenosis tend to develop ventricular conduction problems, which are known adverse events following transcatheter aortic valve implantation (TAVI). Changes in ventricular conduction status after TAVI were analyzed in 195 consecutive patients from a single institute registered in FRANCE2 between February 2010 and June 2012. Among the 195 patients, 29 had a prior pacemaker implantation (+PM) and 6 had acute catastrophic hemodynamics that made a full electrocardiogram (ECG) unavailable. Among the remaining 160, PM was newly required in 28 (17.5%, PM+) but not in 132 (PM-), which included 21 (13.1%) who developed new left bundle branch block (BBB), 12 (7.5%) had right BBB, and 99 (61.9%) had no change. While PM requirement had no correlation with preoperative factors, there was significant association with the development of right BBB with Edwards Sapien/XT (P = 0.003), and new left BBB (P = 0.012) and complete heart block requiring PM with CoreValve (22.6% vs. Edwards Sapien/XT, 7.4%, P = 0.016). Whereas postoperative survival regarding PM status (+PM, PM+, PM-), vascular access, valve size or type showed no difference, delayed heart block (n = 12, Day 2 or later) was associated with poor survival (P = 0.038) compared with the remaining PM+ patients with earlier onset (n = 16, Day 0 or 1). As a result, PM+ patients (n = 28) had significantly longer intensive care unit (ICU) stay and hospitalization than PM- or +PM patients. The results suggest that ventricular conduction problems requiring PM occurred more frequently after TAVI (17.5%) than with usual surgical replacement. Nonetheless, conduction problems failed to influence postoperative survival for up to 3 years on average with use of PM, but therefore did increase medical costs.

Incidence and Importance of New Postoperative Right Bundle Branch Block after Pediatric Orthotopic Heart Transplantation

Purpose Studies have shown right bundle branch block (RBBB) to be the most common ECG abnormality after orthotopic heart transplantation (OHT) in adults, correlating it to higher mean pulmonary artery pressures (PAP) and poorer clinical outcomes. This has not yet been evaluated in pediatric heart transplantation. Methods and Materials We hypothesized that development of RBBB following pediatric OHT would be associated with higher postoperative mean PAP. A retrospective review was conducted of paired donor and recipient ECGs (24-72 hours post-OHT) and clinical data of all patients who had undergone OHT at our center from 2/5/2000 to 6/13/2011. Students T-test, Mann-Whitney U, Chi-Square and Kaplan-Meier analyses were used as appropriate. Results Of 97 pediatric OHT patients, 24 (25%) developed new RBBB and were more likely to be older (11.62 yrs [0.11-17.7yrs] vs. 4.87 yrs [0.5-18.6yrs], p=0.002) and have a higher BSA (1.17m² [0.35-2.07m²] vs. 0.65m² [0.21-1.83m²], p=0.001). There was no association with new RBBB and presence of donor downtime (p=0.35), graft ischemic time (p=0.11), cardiopulmonary bypass time (p=0.35), or elevated donor cardiac enzymes (p=0.62). Development of RBBB was not associated with pre-transplant recipient hemodynamics, including cardiac index (p=0.72), RVEDP (p=0.37), mean PAP (p=0.84), mean RAP (p=0.44), PVRI (p=0.89), or PCWP (p=0.68). Those with RBBB had lower mean PAP on post-OHT cath (6-15 days), both within the normal range (16.4±4.5mmHg vs. 20.2±6.7mmHg, p=0.012). No association was found with any other post-transplant hemodynamic data, evidence of rejection (8% vs. 4%, p=0.68) or ischemia on the first post-op biopsy (25% vs. 22%, p=0.78). New RBBB was not associated with in-hospital mortality (p=0.57), graft survival (p=0.25), or overall mortality (p=0.08). Conclusions While the development of RBBB is a common finding in ECGs following pediatric heart transplantation (25%), it is not associated with any known risk factors or clinical outcomes.

INCIDENCE AND IMPORTANCE OF NEW POSTOPERATIVE RIGHT BUNDLE BRANCH BLOCK AFTER PEDIATRIC ORTHOTOPIC HEART TRANSPLANTATION

Purpose Studies have shown right bundle branch block (RBBB) to be the most common ECG abnormality after orthotopic heart transplantation (OHT) in adults, correlating it to higher mean pulmonary artery pressures (PAP) and poorer clinical outcomes. This has not yet been evaluated in pediatric heart transplantation. Methods and Materials We hypothesized that development of RBBB following pediatric OHT would be associated with higher postoperative mean PAP. A retrospective review was conducted of paired donor and recipient ECGs (24-72 hours post-OHT) and clinical data of all patients who had undergone OHT at our center from 2/5/2000 to 6/13/2011. Students T-test, Mann-Whitney U, Chi-Square and Kaplan-Meier analyses were used as appropriate. Results Of 97 pediatric OHT patients, 24 (25%) developed new RBBB and were more likely to be older (11.62 yrs [0.11-17.7yrs] vs. 4.87 yrs [0.5-18.6yrs], p=0.002) and have a higher BSA (1.17m² [0.35-2.07m²] vs. 0.65m² [0.21-1.83m²], p=0.001). There was no association with new RBBB and presence of donor downtime (p=0.35), graft ischemic time (p=0.11), cardiopulmonary bypass time (p=0.35), or elevated donor cardiac enzymes (p=0.62). Development of RBBB was not associated with pre-transplant recipient hemodynamics, including cardiac index (p=0.72), RVEDP (p=0.37), mean PAP (p=0.84), mean RAP (p=0.44), PVRI (p=0.89), or PCWP (p=0.68). Those with RBBB had lower mean PAP on post-OHT cath (6-15 days), both within the normal range (16.4±4.5mmHg vs. 20.2±6.7mmHg, p=0.012). No association was found with any other post-transplant hemodynamic data, evidence of rejection (8% vs. 4%, p=0.68) or ischemia on the first post-op biopsy (25% vs. 22%, p=0.78). New RBBB was not associated with in-hospital mortality (p=0.57), graft survival (p=0.25), or overall mortality (p=0.08). Conclusions While the development of RBBB is a common finding in ECGs following pediatric heart transplantation (25%), it is not associated with any known risk factors or clinical outcomes.

Prevalence, Patterns of Development, and Prognosis of Right Bundle Branch Block in Heart Transplant Recipients

Right bundle branch block (RBBB) is the most common electrocardiographic abnormality in heart transplant recipients, but the cause remains unknown, data regarding the prognosis are conflicting, and all previous studies have been limited to <100 patients. This was a study of patients who underwent heart transplantation at Stanford University Medical Center from 1981 to 1995 with known outcomes and >or=2 available electrocardiograms (ECGs). Outcomes were assessed in those with and without conduction disturbances recorded from the ECGs closest to the time of transplantation and the most recent ECGs. Of the 322 heart transplant recipients studied, 141 (44%) died over a mean follow-up of 9 +/- 3.5 years, and 40 (13%) died of sudden cardiac death. In the first ECG obtained, a mean of 1.8 +/- 2.4 years after transplantation, 44 patients (14%) had incomplete RBBB and 26 (8%) had RBBB; in the second ECG, obtained a mean of 5.6 +/- 3.7 years after transplantation, 59 patients (18%) had incomplete RBBB and 63 (20%) had RBBB. Increasing time from transplantation was associated with a greater likelihood for RBBB on the first and second ECGs (p = 0.001 and p <0.0001, respectively). QRS duration, incomplete RBBB, RBBB, or the development of RBBB was not associated with mortality or sudden cardiac death. In conclusion, although RBBB was the most common electrocardiographic abnormality in our study, the prevalence was lower than previously reported. The cause of RBBB appears to be largely related to events that occur well after transplantation, and the prognosis is benign.

Incidence and prognostic significance of right bundle branch block in patients with acute myocardial infarction receiving thrombolytic therapy

We assessed the incidence and prognostic significance of right bundle branch block (RBBB) in patients with acute myocardial infarction (AMI) receiving thrombolytic therapy. A prospective, one-year follow-up study involving 681 consecutive patients treated with thrombolytic agents for AMI was performed. Seventy-four patients developed RBBB (46% new-onset, 24% old and 30% indeterminate). RBBB was more common in older patients with large anterior AMI. New-onset RBBB were often transient (56%) and 84% of them resolved within 12 h after admission. Complicating events during the hospital phase, such as ventricular arrhythmias and development of heart failure, were more frequent in patients with RBBB. In-hospital and one-year mortality were higher in patients with RBBB (22.9 and 40.5% compared to 7.9 and 12.3% respectively in patients without block, both p<0.001). New-onset, non-transient RBBB were associated with the highest mortality rates (73% at one-year follow-up). By multivariate analysis, RBBB was retained as independent predictor of in-hospital and one-year mortality. We conclude that new-onset RBBB in patients receiving thrombolytic therapy for AMI is often transient. The development of RBBB has a negative and independent prognostic impact on the survival during the hospital phase and at one-year follow-up.

An electrocardiographic study on the electrical axis of right bundle branch block in the aged.

There were 177 cases of complete right bundle branch block (RBBB) among 3, 698 aged people more than 60 years of age, which was an incidence of 4.8%. Electrical axis was normal in 44 cases (24.8%), left in 92 cases (52.0%) and right in 41 cases (23.2%). RBBB with left axis deviation rather constituted the most important population among the RBBB in the aged. Development of RBBB and axis deviation was examined, and about a half of cases showed stepwise development of both conduction disturbances.