Exercise Pathophysiology Research Laboratory, Cardiology Division, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil.
Am J Cardiol. 2010 Mar 1;105(5):677-80. doi: 10.1016/j.amjcard.2009.10.050.
Exercise-induced (EI) right bundle branch block (RBBB) is an infrequent electrocardiographic phenomenon, and controversy exists regarding its association with cardiovascular disease. We compared the prevalence and prognostic significance of RBBB, abnormal ST depression, and normal electrocardiographic findings in response to exercise testing in 9,623 consecutive veterans who underwent exercise testing from 1987 to 2007. EI RBBB, EI ST depression, and a normal exercise electrocardiographic response occurred in 0.24%, 15.2%, and 71.9% veterans, respectively. After appropriate exclusions, of the 8,047 patients analyzed, 6 patients in the EI RBBB subgroup died. Of these 6 deaths, 3 were cardiovascular deaths during the 9 years of follow-up. The annual death rate was 7.3% (1.4% cardiac deaths), 2.6% (1.2% cardiac deaths), and 1.8% (0.6% cardiac death) among those with EI RBBB, EI ST depression, and a normal ST response, respectively (p <0.0001). The patients with EI RBBB were significantly older, more overweight, and had a greater prevalence of coronary artery disease, heart failure, and hypertension compared to the 2 other subgroups. Patients with EI RBBB had an age-adjusted Cox proportional hazard ratio of 1.13 (p = 0.75, 95% confidence interval 0.51 to 2.5) for all-cause mortality and 1.57 (p = 0.43, 95% confidence interval 0.51 to 4.8) for cardiovascular mortality, respectively. In conclusion, EI RBBB is a rare occurrence during routine clinical exercise testing that appears to be benign.
运动诱发的右束支传导阻滞（RBBB）是一种罕见的心电图现象，其与心血管疾病的关系存在争议。我们比较了在 1987 年至 2007 年期间接受运动试验的 9623 例连续退伍军人中，运动试验时出现 RBBB、异常 ST 压低和正常心电图表现的发生率和预后意义。EI RBBB、EI ST 压低和正常运动心电图反应分别发生在 0.24%、15.2%和 71.9%的退伍军人中。经过适当排除，在分析的 8047 例患者中，EI RBBB 亚组中有 6 例死亡。在这 6 例死亡中，有 3 例在 9 年随访期间死于心血管疾病。EI RBBB、EI ST 压低和正常 ST 反应患者的年死亡率分别为 7.3%（1.4%为心脏性死亡）、2.6%（1.2%为心脏性死亡）和 1.8%（0.6%为心脏性死亡）（p<0.0001）。与后两个亚组相比，EI RBBB 患者年龄更大、超重更多，且冠心病、心力衰竭和高血压的患病率更高。调整年龄后，EI RBBB 患者的全因死亡率和心血管死亡率的 Cox 比例风险比分别为 1.13（p=0.75，95%置信区间 0.51 至 2.5）和 1.57（p=0.43，95%置信区间 0.51 至 4.8）。总之，EI RBBB 在常规临床运动试验中是一种罕见的现象，似乎是良性的。
