Bundle-branch black as a risk factor in noncardiac surgery

Background: Despite extensive data examining perioperative risk in patients with coronary artery disease, little attention has been devoted to the imp lications 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, nonophth almologic, adult patients with BBB seen in our preoperative evaluation cent er. Medical charts were reviewed for data regarding cardiovascular disease, surgical procedure, type of anesthesia, intravascular monitoring, and peri operative 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 tachyar rhythmia. Three of the 4 deaths were sepsis related. There were 2 (0.4%) de aths in the control group. There was no difference in mortality between BBB and control groups (P = .32). Subgroup analysis suggested an increased ris k 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 increa sed in patients with RBBB and not directly attributable to cardiac complica tions in patients with LBBB. These data suggest that the presence of BBB do es not significantly increase the likelihood of cardiac complications follo wing surgery, but that patients with LBBB may not tolerate the stress of pe rioperative noncardiac complications.