Key result
Treat symptomatic AMI with LBBB as STEMI, using concordant ST elevation to guide diagnosis.
Why the study?
Patients presenting with acute myocardial infarction and LBBB require guidance on ECG interpretation and treatment as STEMI despite obscured features.
Patients presenting with symptoms of acute MI and LBBB should be treated as STEMI, and specific ECG criteria (like Sgarbossa criteria) can help identify transmural ischemia despite the bundle branch block.
Supports STEMI-equivalent care for symptomatic LBBB; leaves open optimal ECG thresholds pending prospective validation.
If a patient presents with a clinical syndrome suggesting acute myocardial infarction and the ECG shows LBBB, treat as for ST elevation myocardial infarction (STEMI), whether or not the ECG shows features diagnostic of MI. While LBBB tends to obscure the usual features of STEMI, diagnostic features may still be present (Table I). The most useful are: concordant ST elevation of 1mm or more in any lead; discordant ST elevation of 5mm or more. Diagnostic and localising ST segment elevation may also be present in other conditions affecting ventricular depolarisation, such as paced rhythm, ventricular escape rhythms, accelerated idioventricular rhythm and pre-excitation
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Robert Scott Millar (2017) conducted a review in Acute myocardial infarction with left bundle branch block (LBBB). ECG criteria for MI in LBBB was evaluated. Patients presenting with symptoms of acute myocardial infarction and LBBB should be treated as STEMI, utilizing specific ECG features like concordant ST elevation to aid diagnosis.
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