Right, But Not Left, Bundle Branch Block Is Associated With Large Anteroseptal Scar
Objectives This study sought to test the hypothesis that right bundle branch block (RBBB) patients have larger scar size than left bundle branch block (LBBB) patients do. Background A proximal septal perforating branch of the left anterior descending (LAD) coronary artery most commonly perfuses the...
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| Veröffentlicht in: | Journal of the American College of Cardiology 2013-09, Vol.62 (11), p.959-967 |
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| creator | Strauss, David G., MD, PhD Loring, Zak, MD Selvester, Ronald H., MD Gerstenblith, Gary, MD Tomaselli, Gordon, MD Weiss, Robert G., MD Wagner, Galen S., MD Wu, Katherine C., MD |
| description | Objectives This study sought to test the hypothesis that right bundle branch block (RBBB) patients have larger scar size than left bundle branch block (LBBB) patients do. Background A proximal septal perforating branch of the left anterior descending (LAD) coronary artery most commonly perfuses the right bundle branch and left anterior fascicle, but not the left posterior fascicle. Thus, proximal LAD occlusions should cause RBBB, not LBBB. Methods We performed electrocardiograms and magnetic resonance imaging for scar quantification in 233 patients with left ventricular (LV) ejection fraction ≤35% who were receiving primary prevention implantable cardioverter-defibrillators (ICD cohort). Scar size and location were compared among patients with RBBB, LBBB, nonspecific LV conduction delay, and QRS |
| doi_str_mv | 10.1016/j.jacc.2013.04.060 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3785987</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0735109713019852</els_id><sourcerecordid>1430847223</sourcerecordid><originalsourceid>FETCH-LOGICAL-c568t-ef46136d167971fcb15e18395d14da9f0c713db46752462c4c06316f1c4596743</originalsourceid><addsrcrecordid>eNp9kt9rE0EQxw9RbFr9B3yQBRF88M6d2193IIWk-KMQFIzi47LZm0s2vdzF3U2h_333TGy1Dz4tw3xmdub7nSx7AbQACvLdptgYa4uSAisoL6ikj7IJCFHlTNTqcTahiokcaK1OstMQNpRSWUH9NDspmUo5YJNs8c2t1vEtme0j-TJEMsf2d9Q3HZKZN71dk1k32CtyGcg0hME6E7EhP11ck7nxKyTTPqIfAu6i6cjCGv8se9KaLuDz43uW_fj44fvF53z-9dPlxXSeWyGrmGPLJTDZgFS1gtYuQSBUrBYN8MbULbUKWLPkUomSy9JySyUD2YLlopaKs7Ps_NB3t19usbHYR286vfNua_yNHozT_2Z6t9ar4VozVYm6UqnBm2MDP_zaY4h664LFrjM9DvuggTNacVWWLKGvHqCbYe_7tJ4GyQVL2nKaqPJA2SRI8NjeDQNUj57pjR4906NnmnKdPEtFL_9e467kj0kJeH0ETLCma0dXXLjnlCqp4DJx7w8cJtGvHXodrMPeYuM82qibwf1_jvMH5bZzvUs_XuENhvt9dSg11YvxusbjAkahrkTJbgFOdca-</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1645300040</pqid></control><display><type>article</type><title>Right, But Not Left, Bundle Branch Block Is Associated With Large Anteroseptal Scar</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Strauss, David G., MD, PhD ; Loring, Zak, MD ; Selvester, Ronald H., MD ; Gerstenblith, Gary, MD ; Tomaselli, Gordon, MD ; Weiss, Robert G., MD ; Wagner, Galen S., MD ; Wu, Katherine C., MD</creator><creatorcontrib>Strauss, David G., MD, PhD ; Loring, Zak, MD ; Selvester, Ronald H., MD ; Gerstenblith, Gary, MD ; Tomaselli, Gordon, MD ; Weiss, Robert G., MD ; Wagner, Galen S., MD ; Wu, Katherine C., MD</creatorcontrib><description>Objectives This study sought to test the hypothesis that right bundle branch block (RBBB) patients have larger scar size than left bundle branch block (LBBB) patients do. Background A proximal septal perforating branch of the left anterior descending (LAD) coronary artery most commonly perfuses the right bundle branch and left anterior fascicle, but not the left posterior fascicle. Thus, proximal LAD occlusions should cause RBBB, not LBBB. Methods We performed electrocardiograms and magnetic resonance imaging for scar quantification in 233 patients with left ventricular (LV) ejection fraction ≤35% who were receiving primary prevention implantable cardioverter-defibrillators (ICD cohort). Scar size and location were compared among patients with RBBB, LBBB, nonspecific LV conduction delay, and QRS <120 ms. A second cohort of 20 hypertrophic cardiomyopathy patients undergoing alcohol septal ablation was studied to determine whether controlled infarction in a proximal LAD septal perforator caused RBBB or LBBB. Results In the ICD cohort, LV ejection fraction was similar between RBBB and LBBB patients (24.9% vs. 25.0%; p = 0.98); however, RBBB patients had significantly larger scar size (24.0% vs. 6.5%; p < 0.0001). Patients with nonspecific LV conduction delay or QRS <120 ms had intermediate scar size (12.9% and 14.4%, respectively). Those with RBBB (compared with LBBB) were more likely to have ischemic heart disease (79% vs. 29%; p < 0.0001). In the alcohol septal ablation cohort, 15 of 20 patients (75%) developed RBBB, but no patients developed LBBB. Conclusions In patients with LV ejection fraction ≤35%, RBBB is associated with significantly larger scar size than LBBB is, and occlusion of a proximal LAD septal perforator causes RBBB. In contrast, LBBB is most commonly caused by nonischemic pathologies.</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/j.jacc.2013.04.060</identifier><identifier>PMID: 23707313</identifier><identifier>CODEN: JACCDI</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Ablation Techniques ; Adult ; Aged ; Biological and medical sciences ; Bundle-Branch Block - etiology ; Bundle-Branch Block - physiopathology ; Cardiac dysrhythmias ; Cardiology ; Cardiology. Vascular system ; Cardiomyopathies - complications ; Cardiomyopathies - prevention & control ; Cardiomyopathy ; Cardiovascular ; Cicatrix - etiology ; Cicatrix - pathology ; Cohort Studies ; Coronary Occlusion - complications ; Coronary Occlusion - prevention & control ; Coronary vessels ; Defibrillators, Implantable ; Electrocardiography ; Female ; Heart ; Heart attacks ; Heart Septum - pathology ; Humans ; Internal Medicine ; ischemic heart disease ; left bundle branch block ; Magnetic Resonance Imaging ; Male ; Medical sciences ; Middle Aged ; myocardial infarction ; nonischemic cardiomyopathy ; Prospective Studies ; Review boards ; right bundle branch block ; Stroke Volume ; Veins & arteries ; Ventricular Function, Left</subject><ispartof>Journal of the American College of Cardiology, 2013-09, Vol.62 (11), p.959-967</ispartof><rights>American College of Cardiology Foundation</rights><rights>2013 American College of Cardiology Foundation</rights><rights>2014 INIST-CNRS</rights><rights>Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Sep 10, 2013</rights><rights>2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. 2013</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c568t-ef46136d167971fcb15e18395d14da9f0c713db46752462c4c06316f1c4596743</citedby><cites>FETCH-LOGICAL-c568t-ef46136d167971fcb15e18395d14da9f0c713db46752462c4c06316f1c4596743</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0735109713019852$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=27720546$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23707313$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Strauss, David G., MD, PhD</creatorcontrib><creatorcontrib>Loring, Zak, MD</creatorcontrib><creatorcontrib>Selvester, Ronald H., MD</creatorcontrib><creatorcontrib>Gerstenblith, Gary, MD</creatorcontrib><creatorcontrib>Tomaselli, Gordon, MD</creatorcontrib><creatorcontrib>Weiss, Robert G., MD</creatorcontrib><creatorcontrib>Wagner, Galen S., MD</creatorcontrib><creatorcontrib>Wu, Katherine C., MD</creatorcontrib><title>Right, But Not Left, Bundle Branch Block Is Associated With Large Anteroseptal Scar</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>Objectives This study sought to test the hypothesis that right bundle branch block (RBBB) patients have larger scar size than left bundle branch block (LBBB) patients do. Background A proximal septal perforating branch of the left anterior descending (LAD) coronary artery most commonly perfuses the right bundle branch and left anterior fascicle, but not the left posterior fascicle. Thus, proximal LAD occlusions should cause RBBB, not LBBB. Methods We performed electrocardiograms and magnetic resonance imaging for scar quantification in 233 patients with left ventricular (LV) ejection fraction ≤35% who were receiving primary prevention implantable cardioverter-defibrillators (ICD cohort). Scar size and location were compared among patients with RBBB, LBBB, nonspecific LV conduction delay, and QRS <120 ms. A second cohort of 20 hypertrophic cardiomyopathy patients undergoing alcohol septal ablation was studied to determine whether controlled infarction in a proximal LAD septal perforator caused RBBB or LBBB. Results In the ICD cohort, LV ejection fraction was similar between RBBB and LBBB patients (24.9% vs. 25.0%; p = 0.98); however, RBBB patients had significantly larger scar size (24.0% vs. 6.5%; p < 0.0001). Patients with nonspecific LV conduction delay or QRS <120 ms had intermediate scar size (12.9% and 14.4%, respectively). Those with RBBB (compared with LBBB) were more likely to have ischemic heart disease (79% vs. 29%; p < 0.0001). In the alcohol septal ablation cohort, 15 of 20 patients (75%) developed RBBB, but no patients developed LBBB. Conclusions In patients with LV ejection fraction ≤35%, RBBB is associated with significantly larger scar size than LBBB is, and occlusion of a proximal LAD septal perforator causes RBBB. In contrast, LBBB is most commonly caused by nonischemic pathologies.</description><subject>Ablation Techniques</subject><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Bundle-Branch Block - etiology</subject><subject>Bundle-Branch Block - physiopathology</subject><subject>Cardiac dysrhythmias</subject><subject>Cardiology</subject><subject>Cardiology. Vascular system</subject><subject>Cardiomyopathies - complications</subject><subject>Cardiomyopathies - prevention & control</subject><subject>Cardiomyopathy</subject><subject>Cardiovascular</subject><subject>Cicatrix - etiology</subject><subject>Cicatrix - pathology</subject><subject>Cohort Studies</subject><subject>Coronary Occlusion - complications</subject><subject>Coronary Occlusion - prevention & control</subject><subject>Coronary vessels</subject><subject>Defibrillators, Implantable</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Heart</subject><subject>Heart attacks</subject><subject>Heart Septum - pathology</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>ischemic heart disease</subject><subject>left bundle branch block</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>myocardial infarction</subject><subject>nonischemic cardiomyopathy</subject><subject>Prospective Studies</subject><subject>Review boards</subject><subject>right bundle branch block</subject><subject>Stroke Volume</subject><subject>Veins & arteries</subject><subject>Ventricular Function, Left</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kt9rE0EQxw9RbFr9B3yQBRF88M6d2193IIWk-KMQFIzi47LZm0s2vdzF3U2h_333TGy1Dz4tw3xmdub7nSx7AbQACvLdptgYa4uSAisoL6ikj7IJCFHlTNTqcTahiokcaK1OstMQNpRSWUH9NDspmUo5YJNs8c2t1vEtme0j-TJEMsf2d9Q3HZKZN71dk1k32CtyGcg0hME6E7EhP11ck7nxKyTTPqIfAu6i6cjCGv8se9KaLuDz43uW_fj44fvF53z-9dPlxXSeWyGrmGPLJTDZgFS1gtYuQSBUrBYN8MbULbUKWLPkUomSy9JySyUD2YLlopaKs7Ps_NB3t19usbHYR286vfNua_yNHozT_2Z6t9ar4VozVYm6UqnBm2MDP_zaY4h664LFrjM9DvuggTNacVWWLKGvHqCbYe_7tJ4GyQVL2nKaqPJA2SRI8NjeDQNUj57pjR4906NnmnKdPEtFL_9e467kj0kJeH0ETLCma0dXXLjnlCqp4DJx7w8cJtGvHXodrMPeYuM82qibwf1_jvMH5bZzvUs_XuENhvt9dSg11YvxusbjAkahrkTJbgFOdca-</recordid><startdate>20130910</startdate><enddate>20130910</enddate><creator>Strauss, David G., MD, PhD</creator><creator>Loring, Zak, MD</creator><creator>Selvester, Ronald H., MD</creator><creator>Gerstenblith, Gary, MD</creator><creator>Tomaselli, Gordon, MD</creator><creator>Weiss, Robert G., MD</creator><creator>Wagner, Galen S., MD</creator><creator>Wu, Katherine C., MD</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20130910</creationdate><title>Right, But Not Left, Bundle Branch Block Is Associated With Large Anteroseptal Scar</title><author>Strauss, David G., MD, PhD ; Loring, Zak, MD ; Selvester, Ronald H., MD ; Gerstenblith, Gary, MD ; Tomaselli, Gordon, MD ; Weiss, Robert G., MD ; Wagner, Galen S., MD ; Wu, Katherine C., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c568t-ef46136d167971fcb15e18395d14da9f0c713db46752462c4c06316f1c4596743</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Ablation Techniques</topic><topic>Adult</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Bundle-Branch Block - etiology</topic><topic>Bundle-Branch Block - physiopathology</topic><topic>Cardiac dysrhythmias</topic><topic>Cardiology</topic><topic>Cardiology. Vascular system</topic><topic>Cardiomyopathies - complications</topic><topic>Cardiomyopathies - prevention & control</topic><topic>Cardiomyopathy</topic><topic>Cardiovascular</topic><topic>Cicatrix - etiology</topic><topic>Cicatrix - pathology</topic><topic>Cohort Studies</topic><topic>Coronary Occlusion - complications</topic><topic>Coronary Occlusion - prevention & control</topic><topic>Coronary vessels</topic><topic>Defibrillators, Implantable</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Heart</topic><topic>Heart attacks</topic><topic>Heart Septum - pathology</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>ischemic heart disease</topic><topic>left bundle branch block</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>myocardial infarction</topic><topic>nonischemic cardiomyopathy</topic><topic>Prospective Studies</topic><topic>Review boards</topic><topic>right bundle branch block</topic><topic>Stroke Volume</topic><topic>Veins & arteries</topic><topic>Ventricular Function, Left</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Strauss, David G., MD, PhD</creatorcontrib><creatorcontrib>Loring, Zak, MD</creatorcontrib><creatorcontrib>Selvester, Ronald H., MD</creatorcontrib><creatorcontrib>Gerstenblith, Gary, MD</creatorcontrib><creatorcontrib>Tomaselli, Gordon, MD</creatorcontrib><creatorcontrib>Weiss, Robert G., MD</creatorcontrib><creatorcontrib>Wagner, Galen S., MD</creatorcontrib><creatorcontrib>Wu, Katherine C., MD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Strauss, David G., MD, PhD</au><au>Loring, Zak, MD</au><au>Selvester, Ronald H., MD</au><au>Gerstenblith, Gary, MD</au><au>Tomaselli, Gordon, MD</au><au>Weiss, Robert G., MD</au><au>Wagner, Galen S., MD</au><au>Wu, Katherine C., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Right, But Not Left, Bundle Branch Block Is Associated With Large Anteroseptal Scar</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>2013-09-10</date><risdate>2013</risdate><volume>62</volume><issue>11</issue><spage>959</spage><epage>967</epage><pages>959-967</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><coden>JACCDI</coden><abstract>Objectives This study sought to test the hypothesis that right bundle branch block (RBBB) patients have larger scar size than left bundle branch block (LBBB) patients do. Background A proximal septal perforating branch of the left anterior descending (LAD) coronary artery most commonly perfuses the right bundle branch and left anterior fascicle, but not the left posterior fascicle. Thus, proximal LAD occlusions should cause RBBB, not LBBB. Methods We performed electrocardiograms and magnetic resonance imaging for scar quantification in 233 patients with left ventricular (LV) ejection fraction ≤35% who were receiving primary prevention implantable cardioverter-defibrillators (ICD cohort). Scar size and location were compared among patients with RBBB, LBBB, nonspecific LV conduction delay, and QRS <120 ms. A second cohort of 20 hypertrophic cardiomyopathy patients undergoing alcohol septal ablation was studied to determine whether controlled infarction in a proximal LAD septal perforator caused RBBB or LBBB. Results In the ICD cohort, LV ejection fraction was similar between RBBB and LBBB patients (24.9% vs. 25.0%; p = 0.98); however, RBBB patients had significantly larger scar size (24.0% vs. 6.5%; p < 0.0001). Patients with nonspecific LV conduction delay or QRS <120 ms had intermediate scar size (12.9% and 14.4%, respectively). Those with RBBB (compared with LBBB) were more likely to have ischemic heart disease (79% vs. 29%; p < 0.0001). In the alcohol septal ablation cohort, 15 of 20 patients (75%) developed RBBB, but no patients developed LBBB. Conclusions In patients with LV ejection fraction ≤35%, RBBB is associated with significantly larger scar size than LBBB is, and occlusion of a proximal LAD septal perforator causes RBBB. In contrast, LBBB is most commonly caused by nonischemic pathologies.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>23707313</pmid><doi>10.1016/j.jacc.2013.04.060</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Ablation Techniques Adult Aged Biological and medical sciences Bundle-Branch Block - etiology Bundle-Branch Block - physiopathology Cardiac dysrhythmias Cardiology Cardiology. Vascular system Cardiomyopathies - complications Cardiomyopathies - prevention & control Cardiomyopathy Cardiovascular Cicatrix - etiology Cicatrix - pathology Cohort Studies Coronary Occlusion - complications Coronary Occlusion - prevention & control Coronary vessels Defibrillators, Implantable Electrocardiography Female Heart Heart attacks Heart Septum - pathology Humans Internal Medicine ischemic heart disease left bundle branch block Magnetic Resonance Imaging Male Medical sciences Middle Aged myocardial infarction nonischemic cardiomyopathy Prospective Studies Review boards right bundle branch block Stroke Volume Veins & arteries Ventricular Function, Left |
| title | Right, But Not Left, Bundle Branch Block Is Associated With Large Anteroseptal Scar |
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