Department of Cardiology, Hospital de Denia, Av. Marina Alta, s/n, 03700 Dénia, Alicante, Spain.
Department of Cardiology, Hospital Universitario Santa Lucía de Cartagena, Calle Minarete, s/n, 30202 Cartagena, Murcia, Spain.
Eur Heart J Acute Cardiovasc Care. 2021 Oct 27;10(8):918-925. doi: 10.1093/ehjacc/zuab026.
New-onset right bundle branch block (RBBB) in myocardial infarction (MI) is often associated with ventricular fibrillation (VF) but the nature of this relationship has not been determined.
Between 1998 and 2014, among other data, incidence and duration of RBBB and VF occurrence were prospectively collected in 5301 patients with ST-segment elevation MI (STEMI) admitted to two University Hospitals in Murcia (Spain). Multinomial adjusted logistic regression analyses were used to examine the association between RBBB, attending to its duration, and VF according to its primary VF (PVF) or secondary VF (SVF) character. Among 284 (5.4%) patients with new-onset RBBB, 158 were transient and 126 permanent. VF occurred in 339 (6.4%) patients, 201 PVF and 138 SVF, documented within the first 2 h of symptoms-onset in 78% and 60%, respectively. New-onset RBBB was more frequent in PVF (11.4%) and SVF (20.3%), than in non-VF (4.7%). Transient RBBB incidence was higher in PVF (9.0%) and SVF (9.4) than in non-VF (2.6%), whereas permanent RBBB was higher in SVF (10.9%) than PVF (2.5%) and non-VF (2.1%). New-onset RBBB 1.83 [95% confidence interval (CI): 1.07-3.11] and new-onset transient RBBB 2.39 (95% CI: 1.32-4.32) were independently associated with PVF. New-onset 3.03 (95% CI: 1.83-5.02), transient 2.40 (95% CI: 1.27-4.55), and permanent 2.99 (95% CI: 1.52-5.86) RBBB were independently associated with SVF.
New-onset RBBB and VF in STEMI are independently associated and show particularities based on the duration of the conduction disturbance and/or the primary or secondary character of the arrhythmia.
心肌梗死（MI）中新出现的右束支传导阻滞（RBBB）常伴有心室颤动（VF），但两者的关系尚未确定。
在 1998 年至 2014 年期间，在西班牙穆尔西亚的两家大学医院前瞻性地收集了 5301 例 ST 段抬高型心肌梗死（STEMI）患者的 RBBB 发生率和持续时间以及 VF 发生情况等其他数据。采用多项调整逻辑回归分析来检查新出现的 RBBB 及其持续时间与 VF（原发性 VF [PVF]或继发性 VF [SVF]）之间的关系。在 284 例新发 RBBB 患者中，158 例为一过性，126 例为永久性。VF 发生在 339 例（6.4%）患者中，201 例为原发性 VF，138 例为继发性 VF，分别有 78%和 60%在症状发作的前 2 小时内记录到。新发 RBBB 在原发性 VF（11.4%）和继发性 VF（20.3%）中比非 VF（4.7%）更常见。一过性 RBBB 的发生率在原发性 VF（9.0%）和继发性 VF（9.4%）中高于非 VF（2.6%），而永久性 RBBB 在继发性 VF（10.9%）中高于原发性 VF（2.5%）和非 VF（2.1%）。新发 RBBB 的比值比（OR）为 1.83（95%置信区间[CI]：1.07-3.11），新发一过性 RBBB 的 OR 为 2.39（95% CI：1.32-4.32），与原发性 VF 独立相关。新发 RBBB 的 OR 为 3.03（95% CI：1.83-5.02），新发一过性 RBBB 的 OR 为 2.40（95% CI：1.27-4.55），新发永久性 RBBB 的 OR 为 2.99（95% CI：1.52-5.86），与继发性 VF 独立相关。
STEMI 中新出现的 RBBB 和 VF 是相互独立的，并且根据传导障碍的持续时间和/或心律失常的原发性或继发性特征具有一定的特点。
