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. 2020 Oct 20;9(19):e017430.
doi: 10.1161/JAHA.120.017430. Epub 2020 Sep 14.

Mortality in Patients With Right Bundle-Branch Block in the Absence of Cardiovascular Disease

Prakriti Gaba  1 , Dawn Pedrotty  2 , Christopher V DeSimone  3 , Amanda R Bonikowske  3 , Thomas G Allison  3 , Suraj Kapa  3
Affiliations

Mortality in Patients With Right Bundle-Branch Block in the Absence of Cardiovascular Disease

Prakriti Gaba et al. J Am Heart Assoc. .

Abstract

Background Right bundle-branch block (RBBB) occurs in 0.2% to 1.3% of people and is considered a benign finding. However, some studies have suggested increased risk of cardiovascular morbidity and mortality. We sought to evaluate risk attributable to incidental RBBB in patients without prior diagnosis of cardiovascular disease (CVD). Methods and Results We reviewed the Mayo Clinic Integrated Stress Center database for exercise stress tests performed from 1993 to 2010. Patients with no known CVD-defined as absence of coronary disease, structural heart disease, heart failure, or cerebrovascular disease-were selected. Only Minnesota residents were included, all of whom had full mortality and outcomes data. There were 22 806 patients without CVD identified; 220 of whom (0.96%) had RBBB, followed for 6 to 23 years (mean 12.4±5.1). There were 8256 women (36.2%), mean age was 52±11 years; and 1837 deaths (8.05%), including 645 cardiovascular-related deaths (2.83%), occurred over follow-up. RBBB was predictive of all-cause (hazard ratio [HR], 1.5; 95% CI, 1.1-2.0; P=0.0058) and cardiovascular-related mortality (HR,1.7; 95% CI, 1.1-2.8; P=0.0178) after adjusting for age, sex, diabetes mellitus, hypertension, obesity, current and past history of smoking, and use of a heart rate-lowering drug. Patients with RBBB exhibited more hypertension (34.1% versus 23.7%, P<0.0003), decreased functional aerobic capacity (82±25% versus 90±24%; P<0.0001), slower heart rate recovery (13.5±11.5 versus 17.1±9.4 bpm; P<0.0001), and more dyspnea (28.2% versus 22.4%; P<0.0399) on exercise testing. Conclusions Patients with RBBB without CVD have increased risk of all-cause mortality, cardiovascular-related mortality, and lower exercise tolerance. These data suggest RBBB may be a marker of early CVD and merit further prospective evaluation.

Keywords: ECG; mortality; right bundle‐branch block; stress testing.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1. Indications for referral for stress testing.
Shown are the indications for stress testing in patients with and without right bundle‐branch block (RBBB). Symptoms included dizziness, near‐syncope, syncope, fatigue, or chest pain. Arrhythmias included premature beats and supraventricular tachycardia. Numbers reported are percentage of the overall population. CAD indicates coronary artery disease; and CV, cardiovascular.
Figure 2
Figure 2. Hazard ratios for all‐cause mortality and cardiovascular related mortality in patients with vs without RBBB.
Shown are the hazard ratios for all‐cause mortality (A) and cardiovascular related mortality (B). Note fitness was defined as failure to reach 85% of the target heart rate (HR). Error bars indicate 95% CIs. Note error bars around age and BMI are small for the scale shown. HR‐lowering medications included β blockers, calcium channel blockers, and digoxin. BMI indicates body mass index; CV, cardiovascular; and RBBB, right bundle‐branch block.
Figure 3
Figure 3. Kaplan–Meier survival curve of (A) all‐cause mortality and (B) cardiovascular death in patients with and without right bundle‐branch block (RBBB).
Shown are the Kaplan–Meier survival curves for patients with RBBB (red curves) vs no RBBB (blue curves) over follow‐up.
See this image and copyright information in PMC

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