719-6 Right Bundle Branch Block, ST Segment Elevation and Sudden Cardiac Death. Symptomatic, Asymptomatic and Intermittent Forms

Sudden cardiac death (SCD) in healthy young men was first recognized in 1917. Combined with an electrocardiographic (ECG) abnormality reported in 1953, the resulting syndrome would by 1996 eventually be recognized worldwide as Brugada Syndrome (BrS). There is evidence that “labeling” (i.e. the process of naming a disease state or ascribing a diagnosis) alters perceptions, awareness and behaviours in medicine. Our objective was to determine whether naming a cluster of signs and symptoms as a specific syndrome raised attention given to a previously recognized though poorly defined condition as evidenced through an increase in publications. We hypothesized that naming BrS resulted in such a “labeling” stimulus. A systematic review of the Pubmed database of indexed journals was performed to identify references to BrS between 1950 and 2006. Search terms were: “Brugada Syndrome”; “Sudden Cardiac Death AND Right Bundle Branch Block”; “Bangungot” (Filipino); “Bangungut” (Filipino); “Pok kuri” (Japanese); “Lai tai” (Thai); “Sudden Unexplained Death Syndrome”; and “SUNDS”. Publications identified after 1996 by search strategies other than “Brugada Syndrome” were omitted to avoid double counting. The search resulted in 1,042 citations. Of these, 208 occurred after 1996 and were omitted, leaving a total of 834 citations to be analyzed. Between 1950 and 1993 a total of 32 publications met the above search criteria. Thereafter, publication rate on this topic increased exponentially from 16 articles in 1994-1995 to 290 in 2005-2006. Though numerous articles recognized either RBBB-like ECG pattern, ST segment elevation or SCD in otherwise healthy young men, it was not until publication of the 1992 Brugada and Brugada paper that the coexistence of these two conditions was recognized as a syndrome. Rising interest, as identified by publication frequency, preceded the naming of this syndrome by 4 years. This finding suggests that factors other than labeling have also contributed to the publication history of BrS. Osher H, Wolff L. Electrocardiographic pattern simulating acute myocardial injury. Am J Med Sci 1953; 226:541-5. Brugada P, Brugada J. Right bundle branch block, persisting ST segment elevation and sudden cardiac death: A distinct clinical and electrocardiographic syndrome. J Am Coll Cardiol 1992; 20:1391-6. Yan G-X, Antzelevitch C. Cellular basis for the electrocardiographic J wave. Circulation 1996; 93:372-9.

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O-61 A new report of Brugada's syndrome: Right bundle branch block, persistent ST segment elevation and sudden cardiac death

Resuscitation ◽

10.1016/0300-9572(96)83850-0 ◽

1996 ◽

Vol 31 (3) ◽

pp. S18

Author(s):

Fernando Garcia ◽

Nicolas Serrano

Keyword(s):

Sudden Cardiac Death ◽

Right Bundle Branch Block ◽

Cardiac Death ◽

Bundle Branch Block ◽

St Segment Elevation ◽

St Segment

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Right bundle branch block, persistent ST segment elevation and sudden cardiac death: A distinct clinical and electrocardiographic syndrome

Journal of the American College of Cardiology ◽

10.1016/0735-1097(92)90253-j ◽

1992 ◽

Vol 20 (6) ◽

pp. 1391-1396 ◽

Cited By ~ 2114

Author(s):

Pedro Brugada ◽

Josep Brugada

Keyword(s):

Sudden Cardiac Death ◽

Right Bundle Branch Block ◽

Cardiac Death ◽

Bundle Branch Block ◽

St Segment Elevation ◽

St Segment

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Apparent ST elevation in right bundle branch block pseudo-mimicking myocardial infarction

SAGE Open Medical Case Reports ◽

10.1177/2050313x19827748 ◽

2019 ◽

Vol 7 ◽

pp. 2050313X1982774 ◽

Cited By ~ 1

Author(s):

Itsuro Kazama ◽

Toshiyuki Nakajima

Keyword(s):

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Right Bundle Branch Block ◽

Cardiac Death ◽

Close Monitoring ◽

Bundle Branch Block ◽

St Segment Elevation ◽

Coronary Syndrome ◽

St Segment ◽

St Elevation

We report a case of right bundle branch block, in which the patient’s symptoms and the electrocardiogram findings mimicked those of acute coronary syndrome. In this case report, we stress the significance of apparent ST segment elevation in right bundle branch block. The differential diagnosis is important because right bundle branch block is often complicated with acute coronary syndrome. In addition, right bundle branch block with an ST segment elevation in the specific leads can be a predictor of sudden cardiac death. In such cases, close monitoring of the electrocardiogram findings and careful observation of the patient’s symptoms would be necessary.

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Intraventricular conduction defects in patients with st-segment elevation myocardial infarction – the paradox of right bundle branch block

European Heart Journal ◽

10.1093/ehjci/ehaa946.1615 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Fernandes ◽

F Montenegro ◽

M Cabral ◽

R Carvalho ◽

L Santos ◽

...

Keyword(s):

Hospital Mortality ◽

Right Bundle Branch Block ◽

Independent Predictor ◽

Left Ventricular Ejection ◽

Bundle Branch Block ◽

Hospital Outcomes ◽

St Segment Elevation ◽

Intraventricular Conduction ◽

St Segment ◽

Worse Prognosis

Abstract Intraventricular conduction defects (IVCD) in patients with acute myocardial infarct (AMI) are predictors of a worse prognosis. When acquired they can be the result of an extensive myocardial damage. Purpose To assess the impact of IVCD, regardless of being previously known or presumed new, on in-hospital outcomes of patients with AMI with ST segment elevation (STEMI) or undetermined location. Methods From a series of patients included in the National Registry of Acute Coronary Syndrome between 10/1/2010 and 9/1/2019, were selected patients with STEMI or undetermined AMI, undergoing coronary angiography. Results 7805 patients were included: 461 (5.9%) presenting left bundle branch block (LBBB), 374 (4.8%) with right bundle branch block (RBBB) and 6970 (89.3%) with no IVCD. Clinical characteristics as well as in-hospital outcomes are described in the table 1. An unexpected worse prognosis in patients with RBBB has motivated a multivariate analysis. RBBB remained an independent predictor of in-hospital mortality (OR 1.91, 95% CI 1.04–3.50, p=0.038), along with female gender (OR 1.73, 95% CI 1.11–2.68, p=0.015), Killip Class>1 (OR 2.26, 95% CI 1.45–3.53, p<0.001), left ventricular ejection fraction <50% (OR 3.93, 95% CI 2.19–7.05, p<0.001) and left anterior descending artery as the culprit lesion (OR 1.85, 95% CI 1.16–2.91, p=0.009). Conclusion In spite of an apparent better clinical profile, in the current large series of unselected STEMI patients, the presence of RBBB is associated with the worst in-hospital outcome. RBBB doubles the risk of death, being an independent predictor of in-hospital mortality. Funding Acknowledgement Type of funding source: None

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