Right Bundle Branch Block as a Screening Test for Pulmonary Embolism in Chronic Spinal Cord Injury

• Published in: Archives of physical medicine and rehabilitation Vol. 90; no. 7; pp. 1241 - 1244
• Main Authors: Frisbie, James H., MD, Sharma, G.V.R.K., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.2009; Elsevier
• Subjects: Aged; Biological and medical sciences; Bundle-branch block; Bundle-Branch Block - complications; Bundle-Branch Block - physiopathology; Cardiac dysrhythmias; Cardiology. Vascular system; Chronic Disease; Diseases of the osteoarticular system; Electrocardiography; Female; Heart; Humans; Male; Medical sciences; Physical Medicine and Rehabilitation; Pneumology; Pulmonary embolism; Pulmonary Embolism - diagnosis; Pulmonary Embolism - etiology; Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases; Rehabilitation; Retrospective Studies; Spinal cord injuries; Spinal Cord Injuries - complications; spinal cord injury; right bundle branch block; pulmonary hypertension; ECG; Pulmonary embolism; electrocardiogram; Bundle-branch block; PE; RBBB; PH; SCI; Spinal cord injuries; Rehabilitation; chronic obstructive lung disease; COPD; Nervous system diseases; Arrhythmia; Respiratory disease; Right; Cardiovascular disease; Bundle branch block; Screening test; Conduction disorder; Vascular disease; Chronic; Reeducation; Heart block; Heart disease; Orthopedics; Spinal cord trauma; Central nervous system disease; Spinal cord disease
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/j.apmr.2009.01.013

Abstract Frisbie JH, Sharma GVRK. Right bundle branch block as a screening test for pulmonary embolism in chronic spinal cord injury. Objectives To evaluate right bundle branch block (RBBB) on electrocardiograms (ECGs) as a screening tool for the diagnosis of pulmonary embolism (PE) in a chronic spinal cord injury (SCI) population and to determine the prevalence of PE. Design Retrospective analysis. Setting Boston Veterans Affairs Healthcare System. Participants Consecutive SCI participants (N=112) who were followed at this institution until death between 1999 and 2005 at an average age of 71 years, a duration of paralysis of 31 years, with a tetraplegic level in 62%, and no useful motor function in 84%. Intervention Not applicable. Main Outcome Measures PE, as a cause of RBBB, was diagnosed by autopsy, a source of thromboembolism, imaging, or other ECG signs of PE. Chronic obstructive lung disease was diagnosed by pulmonary function tests and myocardial infarction by ECG or echocardiogram. Results Twenty-nine participants (26%) had RBBB (6 with incomplete RBBB). Evidence that PE caused RBBB was found in 21 (72%), with 4 (3 massive) found by autopsy, 4 by the presence of an embolic source, 3 by imaging, 2 by the intermittent course of RBBB, 1 by abrupt onset of RBBB before death, and 7 by other ECG signs. RBBB represented chronic obstructive lung disease or myocardial infarction in the remaining 8. The onset of RBBB occurred either within months of SCI in 5 (1 before SCI) or years after SCI in 24 (6–50y, median 32y). RBBB was constant in 27 and intermittent in 2. The duration of RBBB ranged from 20 minutes to 31 years, median 4 years. Conclusions RBBB may be a useful initial screening test for PE complicating chronic SCI. PE, often recurrent and sometimes fatal, is prevalent in chronic SCI.