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Bundle-Branch Block as a Risk Factor in Noncardiac Surgery
Todd Dorman, MD;
Michael J. Breslow, MD;
Peter J. Pronovost, MD;
Peter Rock, MD;
Brian A. Rosenfeld, MD
Arch Intern Med. 2000;160:1149-1152.
Background Despite extensive data examining perioperative risk in patients with coronary artery disease, little attention has been devoted to the implications of conduction system abnormalities.
Objective To define the clinical significance of bundle-branch block (BBB) as a perioperative risk factor.
Methods Retrospective, cohort-controlled study of all noncardiac, nonophthalmologic, adult patients with BBB seen in our preoperative evaluation center. Medical charts were reviewed for data regarding cardiovascular disease, surgical procedure, type of anesthesia, intravascular monitoring, and perioperative complications.
Results Bundle-branch block was present in 455 patients. Right BBB (RBBB) was more common than left BBB (LBBB) (73.8% vs 26.2%). Three patients with LBBB and 1 patient with RBBB died; 1 patient had a supraventricular tachyarrhythmia. Three of the 4 deaths were sepsis related. There were 2 (0.4%) deaths in the control group. There was no difference in mortality between BBB and control groups (P=.32). Subgroup analysis suggested an increased risk for death in patients with LBBB vs controls (P=.06; odds ratio, 6.0; 95% confidence interval, 1.2-100.0) and vs RBBB (P=.06; odds ratio, 8.7; 95% confidence interval, 1.2-100.0).
Conclusions The presence of BBB is not associated with a high incidence of postoperative cardiac complications. Perioperative mortality is not increased in patients with RBBB and not directly attributable to cardiac complications in patients with LBBB. These data suggest that the presence of BBB does not significantly increase the likelihood of cardiac complications following surgery, but that patients with LBBB may not tolerate the stress of perioperative noncardiac complications.
From the Departments of Anesthesiology–Critical Care Medicine and Medicine and Surgery, The Johns Hopkins University School of Medicine, Baltimore, Md (Drs Dorman, Breslow, Pronovost, and Rosenfeld); and the Departments of Anesthesiology and Medicine, Washington University School of Medicine, St Louis, Mo (Dr Rock).
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