(Circulation. 1996;94:2424-2428.)
© 1996 American Heart Association, Inc.
Articles |
Incidence and Clinical Relevance of the Occurrence of Bundle-Branch Block in Patients Treated With Thrombolytic Therapy
Duke University/VA Medical Center, Durham, NC.
Correspondence to Andrea Natale, MD, VA Medical Center, 508 Fulton St, Box 111A, Durham, NC 27705.
Background Whether thrombolytic therapy alters the incidence and clinical outcome of bundle-branch block is unclear.
Methods and Results We examined the occurrence of new-onset bundle-branch block, both transient and persistent, in 681 patients with acute myocardial infarction enrolled in the Thrombolysis and Angioplasty in Myocardial Infarction 9 and Global Utilization of Streptokinase and t-PA for Occluded Arteries 1 protocols. Each patient underwent continuous 12-lead ECG monitoring for 36 to 72 hours with the Mortara ST monitoring system. Bundle-branch block was characterized as right, left, alternating, transient, or persistent. The overall incidence of bundle-branch block was 23.6% (n=161), with transient block in 18.4% (n=125) and persistent block in 5.3% (n=36). Right bundle-branch block was found in 13% (n=89) of the population; left bundle-branch block was found in 7% (n=48). Alternating bundle-branch block was seen in 3.5% (n=24) of patients. Left anterior descending artery infarcts accounted for most bundles (54%, n=79). Patients with bundle-branch block had lower ejection fractions, higher peak creatine phosphokinase levels (P<.0001), and more diseased vessels (P<.019). Mortality rates in patients with and without bundle-branch block were 8.7% and 3.5%, respectively (P<.007). A higher mortality rate was observed in the presence of persistent (19.4%) versus transient (5.6%) or no (3.5%) bundle-branch block (P<.001).
Conclusions Thrombolytic therapy reduces the overall mortality rate associated with persistent bundle-branch block. However, persistent bundle-branch block remains predictive of a higher mortality rate than either transient or no bundle-branch block. Continuous 12-lead ECG monitoring provides an accurate characterization of the incidence and type of conduction disturbances after acute myocardial infarction.
Key Words: bundle-branch block • myocardial infarction • conduction • mortality • thrombolysis
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