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(Circulation. 1974;50:935.)
© 1974 American Heart Association, Inc.

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Factors Influencing Prognosis of Bundle Branch Block Complicating Acute Antero-Septal Infarction

The Value of His Bundle Recordings

K. I. LIE M.D.¹; HEIN J. WELLENS M.D.¹; REINIER M. SCHUILENBURG M.D.¹; ANTON E. BECKER M.D.¹; DIRK DURRER M.D.¹

¹ From the Department of Cardiology and Clinical Physiology and the Department of Pathology, University of Amsterdam, Wilhelmina Gasthuis, Amsterdam.

Of 50 consecutive patients with bundle branch block (BBB) complicating acute antero-septal infarction, 37 died in hospital. Patients with BBB of delayed onset or BBB of short duration had a significantly lower mortality. His bundle recordings were made in 35 patients without pulmonary edema or shock at the time of appearance of BBB. Thirteen of 16 patients with prolonged H-V intervals died compared to nine of 19 with normal H-V intervals (P < 0.05). In patients with bifascicular block, 11 of 15 with prolonged H-V intervals developed complete A-V block compared to one of ten with normal H-V intervals (P < 0.005).

Twenty-five of 33 patients with normal P-R intervals died compared to eight of 12 with first degree A-V block. Seven of 15 patients with prolonged H-V intervals had normal P-R intervals and four of these seven developed complete A-V block. We conclude that the length of P-R interval has no prognostic significance and is of limited value in predicting both prolonged H-V interval and development of complete A-V block. In contrast, His bundle recordings are of value in identifying patients with BBB complicating antero-septal infarction who are at immediate high risk for development of complete A-V block and death.

Key Words: Bifascicular block • Complete A-V block • His bundle electrogram

Submitted on May 6, 1974
Accepted on July 9, 1974

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