Primary angioplasty in acute myocardial infarction with right bundle branch block: should new onset right bundle branch block be added to future guidelines as an indication for reperfusion therapy?

Widimský, Petr; Roháč, Filip; Štásek, Josef; Kala,  Petr; Rokyta, Richard; Kuzmanov, Boyko; Jakl, Martin; Poloczek,  Martin; Kaňovský,  Jan; Bernat, Ivo; Hlinomaz, Ota; Bělohlávek, Jan; Král, Aleš; Mrázek, Vratislav; Grigorov, Vladimir; Djambazov, Slavyeko; Petr, Robert; Knot, Jiří; Bílková, Dana; Fischerová, Michaela; Vondrák, Karel; Malý, Radek; Lorencová, Alena

Primary angioplasty in acute myocardial infarction with right bundle branch block: should new onset right bundle branch block be added to future guidelines as an indication for reperfusion therapy?

Authors	WIDIMSKÝ Petr ROHÁČ Filip ŠTÁSEK Josef KALA Petr ROKYTA Richard KUZMANOV Boyko JAKL Martin POLOCZEK Martin KAŇOVSKÝ Jan BERNAT Ivo HLINOMAZ Ota BĚLOHLÁVEK Jan KRÁL Aleš MRÁZEK Vratislav GRIGOROV Vladimir DJAMBAZOV Slavyeko PETR Robert KNOT Jiří BÍLKOVÁ Dana FISCHEROVÁ Michaela VONDRÁK Karel MALÝ Radek LORENCOVÁ Alena
Year of publication	2012
Type	Article in Periodical
Magazine / Source	European Heart Journal
MU Faculty or unit	Faculty of Medicine
Citation
Doi	http://dx.doi.org/10.1093/eurheartj/ehr291
Field	Cardiovascular diseases incl. cardiosurgery
Keywords	Acute myocardial infarction; Right bundle branch block; Left bundle branch block; Primary angioplasty ; Reperfusion
Description	Aims: The current guidelines recommend reperfusion therapy in acute myocardial infarction (AMI) with ST-segment elevation or left bundle branch block (LBBB). Surprisingly, the right bundle branch block (RBBB) is not listed as an indication for reperfusion therapy. This study analysed patients with AMI presenting with RBBB [with or without left anterior hemiblock (LAH) or left posterior hemiblock (LPH)] and compared them with those presenting with LBBB or with other electrocardiographic (ECG) patterns. The aim was to describe angiographic patterns and primary angioplasty use in AMI patients with RBBB. Conclusion: Acute myocardial infarction with RBBB is frequently caused by the complete occlusion of the infarct-related artery and is more frequently treated with primary PCI when compared with AMI + LBBB. In-hospital mortality of patients with AMI and RBBB is highest from all ECG presentations of AMI. Restoration of coronary flow by primary PCI may lead to resolution of the conduction delay on the discharge ECG. Right bundle branch block should strongly be considered for listing in future guidelines as a standard indication for reperfusion therapy, in the same way as LBBB.