title: Bundle-branch block as a risk factor in noncardiac surgery.
abstract: 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.
authors.affiliation: Department of Anesthesiology-Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. tdorman@jhmi.edu
authors.forename: T
authors.initials: T
authors.lastname: Dorman
authors.forename: M J
authors.initials: MJ
authors.lastname: Breslow
authors.forename: P J
authors.initials: PJ
authors.lastname: Pronovost
authors.forename: P
authors.initials: P
authors.lastname: Rock
authors.forename: B A
authors.initials: BA
authors.lastname: Rosenfeld
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002037:Bundle-Branch Block / Q000209:etiology*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012307:Risk Factors