The Prognostic Significance of Right Bundle Branch Block: A Meta-analysis of Prospective Cohort Studies

Overview

Journal Clin Cardiol

Specialty Cardiology & Vascular Diseases

Date 2015 Oct 6

PMID 26436874

Citations 20

Authors

Yunyun Xiong

Lian Wang

Wenyan Liu

Graeme J Hankey

Biao Xu

Shang Wang

Affiliations

Soon will be listed here.

Abstract

Background: The prognostic significance of right bundle branch block (RBBB) is inconsistent across studies. We aimed to assess the association between RBBB (in general population and patients with heart disease) and risk of all-cause mortality, cardiac death, acute myocardial infarction (MI), and heart failure (HF).

Hypothesis: RBBB may be associated with increased risk of death.

Methods: PubMed, EMBASE, and the Cochrane Library up to February 2015 were searched for prospective cohort studies that reported RBBB at baseline and all-cause mortality, cardiac death, MI, and HF at follow-up. A meta-analysis of published data was undertaken primarily by means of fixed-effects models.

Results: Nineteen cohort studies including 201 437 participants were included with a mean follow-up period ranging from 1 to 246 months. For general population with RBBB, the pooled adjusted hazard ratio (HR) for all-cause mortality was 1.17 (95% confidence interval [CI]: 1.03-1.33) compared with no BBB. General population with RBBB had an increased risk of cardiac death (HR: 1.43, 95% CI: 1.17-1.74). For patients with RBBB and acute MI, the pooled risk ratio was 2.31 (95% CI: 2.13-2.49) for in-hospital mortality, 2.85 (95% CI: 2.46-3.30) for 30-day mortality, and 1.96 (95% CI: 1.59-2.42) for longer-term mortality. For acute HF patients, the pooled risk ratio of all-cause mortality was 1.11 (95% CI: 1.06-1.16), and for chronic HF patients it was 1.75 (95% CI: 1.38-2.22).

Conclusions: Right bundle branch block is associated with an increased risk of mortality in general population and patients with heart disease.

Citing Articles

Transient right bundle branch block (RBBB) and S1Q3T3 in a transit passenger due to acute pulmonary embolism- a case report.

Iftikhar H, Sabir D, Najam M, Noor A, Anjum S Oxf Med Case Reports. 2025; 2025(1):omae165.

PMID: 39839691 PMC: 11748387. DOI: 10.1093/omcr/omae165.

Evaluation of ST-segment and T-wave changes associated with NSTE-ACS in patients with RBBB: a nested case-control study design.

Duyan M, Ibze S, Vural N, Guven H, Ertas E, Avci R Intern Emerg Med. 2025; .

PMID: 39755871 DOI: 10.1007/s11739-024-03855-6.

Prognosis of patients with nonspecific electrocardiogram findings in a Tanzanian emergency department.

Sarafian J, Sakita F, Mlangi J, Kweka G, Tarimo T, Kessy M Am Heart J. 2024; 281:10-19.

PMID: 39577681 PMC: 11810590. DOI: 10.1016/j.ahj.2024.11.006.

Ventricular dysfunction consequences of mechanical dyssynchrony in isolated complete right bundle branch block versus left bundle branch block.

Chen M, Zhang X, Li G, Wang Y, Kong F, Ma C Quant Imaging Med Surg. 2024; 14(8):5650-5664.

PMID: 39144058 PMC: 11320498. DOI: 10.21037/qims-23-959.

Generalization challenges in electrocardiogram deep learning: insights from dataset characteristics and attention mechanism.

Huang Z, MacLachlan S, Yu L, Herbozo Contreras L, Truong N, Ribeiro A Future Cardiol. 2024; 20(4):209-220.

PMID: 39049767 PMC: 11285255. DOI: 10.1080/14796678.2024.2354082.

References

Ashley E, Raxwal V, Froelicher V . The prevalence and prognostic significance of electrocardiographic abnormalities. Curr Probl Cardiol. 2000; 25(1):1-72. DOI: 10.1016/s0146-2806(00)70020-x. View

Hesse B, Diaz L, Snader C, Blackstone E, Lauer M . Complete bundle branch block as an independent predictor of all-cause mortality: report of 7,073 patients referred for nuclear exercise testing. Am J Med. 2001; 110(4):253-9. DOI: 10.1016/s0002-9343(00)00713-0. View

Higgins J, Thompson S . Quantifying heterogeneity in a meta-analysis. Stat Med. 2002; 21(11):1539-58. DOI: 10.1002/sim.1186. View

Denes P, Dhingra R, Wu D, Chuquimia R, Wyndham C, Rosen K . H-V interval in patients with bifascicular block (right bundle branch block and left anterior hemiblock). Clinical, electrocardiographic and electrophysiologic correlations. Am J Cardiol. 1975; 35(1):23-9. DOI: 10.1016/0002-9149(75)90554-8. View

Taniguchi M, Nakano H, Kuwahara K, Masuda I, Okawa Y, Miyazaki H . Prognostic and clinical significance of newly acquired complete right bundle branch block in Japan Airline pilots. Intern Med. 2003; 42(1):21-4. DOI: 10.2169/internalmedicine.42.21. View

Baldasseroni S, Gentile A, Gorini M, Marchionni N, Marini M, Masotti G . Intraventricular conduction defects in patients with congestive heart failure: left but not right bundle branch block is an independent predictor of prognosis. A report from the Italian Network on Congestive Heart Failure (IN-CHF database). Ital Heart J. 2003; 4(9):607-13. View

Zimetbaum P, Buxton A, Batsford W, Fisher J, Hafley G, Lee K . Electrocardiographic predictors of arrhythmic death and total mortality in the multicenter unsustained tachycardia trial. Circulation. 2004; 110(7):766-9. DOI: 10.1161/01.CIR.0000139311.32278.32. View

McCullough P, Hassan S, Pallekonda V, Sandberg K, Nori D, Soman S . Bundle branch block patterns, age, renal dysfunction, and heart failure mortality. Int J Cardiol. 2005; 102(2):303-8. DOI: 10.1016/j.ijcard.2004.10.008. View

Eriksson P, Wilhelmsen L, Rosengren A . Bundle-branch block in middle-aged men: risk of complications and death over 28 years. The Primary Prevention Study in Göteborg, Sweden. Eur Heart J. 2005; 26(21):2300-6. DOI: 10.1093/eurheartj/ehi580. View

10.

Wong C, Stewart R, Gao W, French J, Raffel C, White H . Prognostic differences between different types of bundle branch block during the early phase of acute myocardial infarction: insights from the Hirulog and Early Reperfusion or Occlusion (HERO)-2 trial. Eur Heart J. 2005; 27(1):21-8. DOI: 10.1093/eurheartj/ehi622. View

11.

Kleemann T, Juenger C, Gitt A, Schiele R, Schneider S, Senges J . Incidence and clinical impact of right bundle branch block in patients with acute myocardial infarction: ST elevation myocardial infarction versus non-ST elevation myocardial infarction. Am Heart J. 2008; 156(2):256-61. DOI: 10.1016/j.ahj.2008.03.003. View

12.

Iwasaki J, Kono K, Katayama Y, Takahashi N, Takeuchi K, Tanakaya M . Prognostic significance of right bundle branch block in patients with acute inferior myocardial infarction. Acta Med Okayama. 2009; 63(1):25-33. DOI: 10.18926/AMO/31857. View

13.

Stein R, Nguyen P, Abella J, Olson H, Myers J, Froelicher V . Prevalence and prognostic significance of exercise-induced right bundle branch block. Am J Cardiol. 2010; 105(5):677-80. DOI: 10.1016/j.amjcard.2009.10.050. View

14.

Abdel-Qadir H, Tu J, Austin P, Wang J, Lee D . Bundle branch block patterns and long-term outcomes in heart failure. Int J Cardiol. 2010; 146(2):213-8. DOI: 10.1016/j.ijcard.2010.01.012. View

15.

Manzano L, Babalis D, Roughton M, Shibata M, Anker S, Ghio S . Predictors of clinical outcomes in elderly patients with heart failure. Eur J Heart Fail. 2011; 13(5):528-36. DOI: 10.1093/eurjhf/hfr030. View

16.

Widimsky P, Rohac F, Stasek J, Kala P, Rokyta R, Kuzmanov B . Primary angioplasty in acute myocardial infarction with right bundle branch block: should new onset right bundle branch block be added to future guidelines as an indication for reperfusion therapy?. Eur Heart J. 2011; 33(1):86-95. PMC: 3249219. DOI: 10.1093/eurheartj/ehr291. View

17.

Zhang Z, Rautaharju P, Soliman E, Manson J, Cain M, Martin L . Mortality risk associated with bundle branch blocks and related repolarization abnormalities (from the Women's Health Initiative [WHI]). Am J Cardiol. 2012; 110(10):1489-95. DOI: 10.1016/j.amjcard.2012.06.060. View

18.

Bussink B, Holst A, Jespersen L, Deckers J, Jensen G, Prescott E . Right bundle branch block: prevalence, risk factors, and outcome in the general population: results from the Copenhagen City Heart Study. Eur Heart J. 2012; 34(2):138-46. DOI: 10.1093/eurheartj/ehs291. View

19.

Juarez-Herrera U, Jerjes-Sanchez C . Risk factors, therapeutic approaches, and in-hospital outcomes in Mexicans with ST-elevation acute myocardial infarction: the RENASICA II multicenter registry. Clin Cardiol. 2013; 36(5):241-8. PMC: 6649652. DOI: 10.1002/clc.22107. View

20.

Cinca J, Mendez A, Puig T, Ferrero A, Roig E, Vazquez R . Differential clinical characteristics and prognosis of intraventricular conduction defects in patients with chronic heart failure. Eur J Heart Fail. 2013; 15(8):877-84. PMC: 3721573. DOI: 10.1093/eurjhf/hft042. View