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November 20, 1972, Vol 222, No. 8 >
ARTICLE | November 20, 1972

Bundle-Branch Block Complicating Acute Myocardial Infarction FREE

Stephen Scheidt, MD; Thomas Killip, MD
[+] Author Affiliations

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JAMA. 1972;222(8):919-924. doi:10.1001/jama.1972.03210080011003
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References

Nineteen patients with right bundle-branch block (RBBB) and 20 with left bundle-branch block (LBBB) were treated in a coronary care unit for acute myocardial infarction during a 4 1/2-year period. Twenty-six percent of patients with RBBB developed cardiogenic shock, 32% had complete atrioventricular block, and 26% had ventricular asystole. Mortality was 37%, primarily from myocardial failure rather than asystole or arrhythmia. Pacemaker therapy was generally unsuccessful in reducing mortality. In contrast, 70% of the group with LBBB suffered life-threatening ventricular arrhythmia during or in close proximity to the acute phase of myocardial infarction. Mortality was 35%. Electrophysiologic mechanisms may influence ventricular irritability in patients with LBBB and ischemic heart disease. Consideration should be given to prophylactic antiarrhythmic therapy in these patients at least during hospitalization for acute myocardial infarction.

REFERENCES

1 +
Sutton R, Davies M:  The conduction system in acute myocardial infarction complicated by heart block . Circulation 38:987-992, 1968;.
2 +
Stock RJ, Macken DL:  Observations on heart block during continuous electrocardiographic monitoring in myocardial infarction . Circulation 38:993-1005, 1968;.
3 +
Godman MJ, Lassers BW, Julian DG:  Complete bundle-branch block complicating acute myocardial infarction . New Eng J Med 282:237-240, 1970;.
4 +
Norris RM, Croxson MS:  Bundle-branch block in acute myocardial infarction . Amer Heart J 79:728-733, 1970;.
5 +
Scanlon PJ, Pryor R, Blount SG:  Right bundle-branch block associated with left superior or inferior intraventricular block: Associated with acute myocardial infarction . Circulation 42:1135-1142, 1970;.
6 +
Hunt D, Sloman G:  Bundle-branch block in acute myocardial infarction . Brit Med J 1:85-88, 1969;.
7 +
Master AM, Dack S, Jaffee HL:  Conduction defects in coronary occlusion . Amer Heart J 16:283-308, 1938;.
8 +
Bauer GE, Julian DG, Valentine PA:  Bundle-branch block in acute myocardial infarction . Brit Heart J 27:724-730, 1965;.
9 +
Hipp HR, Beard OW, Taylor JS, et al:  Initial myocardial infarction among veterans: Nontransmural myocardial infarction. Bundle-branch block . Amer Heart J 62:43-50, 1961;.
10 +
Rodstein M, Gubner R, Mills JP, et al:  A mortality study in bundle-branch block . Arch Intern Med 87:663-668, 1951;.
11 +
Smith S, Hayes WL:  The prognosis of complete left bundle-branch block . Amer Heart J 70:157-159, 1965;.
12 +
Vazifdar JP, Levine SA:  Benign bundle-branch block . Arch Intern Med 89:568-574, 1952;.
13 +
Langley RW, Reed JC, Utz DC:  Bundle-branch block: A review of 100 cases , abstracted. Amer Heart J 33:730, 1947;.
14 +
Beach TB, Gracey JG, Peter RH, et al:  Benign left bundle-branch block . Ann Intern Med 70:269-276, 1969;.
15 +
Haft JI, Herman MU, Gorlin R:  Left bundle-branch block. Etiologic, hemodynamic and ventricularographic considerations . Circulation 43:279-288, 1971;.
16 +
Chiang BN, Perlamn LV, Fulton M, et al:  Predisposing factors in sudden cardiac death in Tecumseh, Michigan: A prospective study . Circulation 41:31-38, 1970;.
17 +
Hinkle LE, Carver ST, Stevens M:  The frequency of asymptomatic disturbances of cardiac rhythm and conduction in middle aged men . Amer J Cardiol 24:629-650, 1969;.
18 +
Han J, Moe GK:  Non-uniform recovery of excitability in ventricular muscle . Circ Res 14:44-60, 1964;.
19 +
Han J:  Mechanisms of ventricular arrhythmias associated with myocardial infarction . Amer J Cardiol 24:800-813, 1969;.

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1 +
Sutton R, Davies M:  The conduction system in acute myocardial infarction complicated by heart block . Circulation 38:987-992, 1968;.
2 +
Stock RJ, Macken DL:  Observations on heart block during continuous electrocardiographic monitoring in myocardial infarction . Circulation 38:993-1005, 1968;.
3 +
Godman MJ, Lassers BW, Julian DG:  Complete bundle-branch block complicating acute myocardial infarction . New Eng J Med 282:237-240, 1970;.
4 +
Norris RM, Croxson MS:  Bundle-branch block in acute myocardial infarction . Amer Heart J 79:728-733, 1970;.
5 +
Scanlon PJ, Pryor R, Blount SG:  Right bundle-branch block associated with left superior or inferior intraventricular block: Associated with acute myocardial infarction . Circulation 42:1135-1142, 1970;.
6 +
Hunt D, Sloman G:  Bundle-branch block in acute myocardial infarction . Brit Med J 1:85-88, 1969;.
7 +
Master AM, Dack S, Jaffee HL:  Conduction defects in coronary occlusion . Amer Heart J 16:283-308, 1938;.
8 +
Bauer GE, Julian DG, Valentine PA:  Bundle-branch block in acute myocardial infarction . Brit Heart J 27:724-730, 1965;.
9 +
Hipp HR, Beard OW, Taylor JS, et al:  Initial myocardial infarction among veterans: Nontransmural myocardial infarction. Bundle-branch block . Amer Heart J 62:43-50, 1961;.
10 +
Rodstein M, Gubner R, Mills JP, et al:  A mortality study in bundle-branch block . Arch Intern Med 87:663-668, 1951;.
11 +
Smith S, Hayes WL:  The prognosis of complete left bundle-branch block . Amer Heart J 70:157-159, 1965;.
12 +
Vazifdar JP, Levine SA:  Benign bundle-branch block . Arch Intern Med 89:568-574, 1952;.
13 +
Langley RW, Reed JC, Utz DC:  Bundle-branch block: A review of 100 cases , abstracted. Amer Heart J 33:730, 1947;.
14 +
Beach TB, Gracey JG, Peter RH, et al:  Benign left bundle-branch block . Ann Intern Med 70:269-276, 1969;.
15 +
Haft JI, Herman MU, Gorlin R:  Left bundle-branch block. Etiologic, hemodynamic and ventricularographic considerations . Circulation 43:279-288, 1971;.
16 +
Chiang BN, Perlamn LV, Fulton M, et al:  Predisposing factors in sudden cardiac death in Tecumseh, Michigan: A prospective study . Circulation 41:31-38, 1970;.
17 +
Hinkle LE, Carver ST, Stevens M:  The frequency of asymptomatic disturbances of cardiac rhythm and conduction in middle aged men . Amer J Cardiol 24:629-650, 1969;.
18 +
Han J, Moe GK:  Non-uniform recovery of excitability in ventricular muscle . Circ Res 14:44-60, 1964;.
19 +
Han J:  Mechanisms of ventricular arrhythmias associated with myocardial infarction . Amer J Cardiol 24:800-813, 1969;.

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