Cardiovascular Risk in Young Workers with Left Bundle Branch Block

Monica Lamberti, Gennaro Ratti, Giuseppina Di Miscio, Emilio Franciolini, Michele Pincone, Cristina Capogrosso, Carlo Tedeschi, Roberto De Rosa

Cardiology and Radiology Unit, “Cliniche Riunite” Hospital, Foggia, Italy.
Cardiology and Radiology Unit, “S. Gennaro” Hospital, Naples, Italy.
Cardiology Unit, “S. Giovanni Bosco” Hospital, Naples, Italy.
Section of Occupational Medicine, Department of Experimental Medicine Second University of Naples, Naples, Italy.

DOI: 10.4236/ojpm.2014.45033                

Abstract

Aims: Left bundle branch block (LBBB) is generally associated with a poorer prognosis in comparison to normal intraventricular conduction, but also in comparison to right bundle branch block which is generally considered to be benign in the absence of an underlying cardiac disorder like congenital heart disease. In this paper we evaluate the presence of possible cardiovascular pathology in a group of nurses with a low level of cardiovascular risk factors and left bundle branch block (LBBB). Methods: During the period 2009-2013, 356 nurses (mean age: 32.6 ± 11 yr) were admitted to the department of Occupational Medicine of Second University of Naples. Of these, 13 had LBBB. The evaluation of these patients has included an electrocardiogram (ECG), echocardiography, 24-h ambulatory Holter monitoring (ECG Holter), and exercise testing. Subsequently, in patients with LBBB, multislice computed coronary angiography (MSCT) has been considered. Results and Conclusion: Only in one patient we found a significant stenosis in the middle tract of left anterior descending artery. Coronary artery disease remains difficult to diagnose in some ECG findings such as acquired LBBB. For this reason, a preventive diagnose with newly developed diagnostic methods such as the multislice computed coronary angiography (MSCT) must try to account by the clinician in order to ruling out coronary artery disease (CAD) in workers with LBBB and low cardiovascular risk.

Keywords

Left Bundle Branch Block, Coronary Artery Disease, Nurses

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Francia, P., Balla, C., Paneni, F. and Volpe, M. (2007) Left Bundle-Branch Block—Pathophysiology, Prognosis, and Clinical Management. Clinical Cardiology, 30, 110-115. http://dx.doi.org/10.1002/clc.20034
[2]	Picciotto, D., Verso, M.G., Grant, M. and Cannizzaro, E. (1998) Rhythm and Conduction Disorders in Formulating a Judgment of Work Fitness. Med Lav Medicina del Lavoro, 89, 387-392.
[3]	Gilard, M., Le Gal, G., Cornily, J.C., Vinsonneau, U., Joret, C., Pennec, P.Y., Mansourati, J. and Boschat, J. (2007) Mid Term Prognosis of Patients with Suspected Coronary Artery Disease and Normal Multislice Computed Tomographic Findings. A Prospective Management Outcome Study. Archives of Internal Medicine, 165, 1686-1689. http://dx.doi.org/10.1001/archinte.167.15.1686
[4]	Carrigan, T.P., Nair, D., Schoenhagen, P., Curtin, R.J., Popovic, Z.B., Halliburton, S., Kuzmiak, S., White, R.D., Flamm, S.D. and Desai, M.Y. (2009) Prognostic Utility of 64-Slice Computer Tomography in Patients with Suspected but No Documented Coronary Artery Disease. European Heart Journal, 30, 362-371. http://dx.doi.org/10.1093/eurheartj/ehn605
[5]	Achenbach, S., Ropers, D., Hoffmann, U., et al. (2004) Assessment of Coronary Remodeling in Stenotic and Nonstenotic Coronary Atherosclerotic Lesions by Multidetector Spiral Computed Tomography. Journal of the American College of Cardiology, 43, 842-847. http://dx.doi.org/10.1016/j.jacc.2003.09.053
[6]	Conroy, R.M., Pyorala, K., Fitzgerald, A.P., et al. (2003) Estimation of Ten-Risk of Cardiovascular Disease in Europe: The SCORE Project. European Heart Journal, 24, 987-1003. http://dx.doi.org/10.1016/S0195-668X(03)00114-3
[7]	Criteria Committee of the New York Heart Association (1994) Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels. 9th Edition, Little Brown, Boston, 210-219.
[8]	Austen, W.G., Edwards, J.E., Frye, R.L., et al. (1975) A Reporting System on Patients Evaluated for Coronary Artery Disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation, 51, 5-40. http://dx.doi.org/10.1161/01.CIR.51.4.5
[9]	Zanettini, R. and Farina, G. (2004) Work Capacity and Re-Entry into the Workforce for the Cardiac Patient. Med Lav Medicina del Lavoro, 95, 140-144.
[10]	Lee, S.M. and Koh, D. (2008) Fitness to Work: Legal Pitfalls. Annals of the Academy of Medicine, Singapore, 37, 236-240.
[11]	Schneider, J.F., Thomas Jr., H.E., Kreger, B.E., et al. (1979) Newly Acquired Left Bundle Branch Block. The Framingham Study. Annals of Internal Medicine, 90, 303-310. http://dx.doi.org/10.7326/0003-4819-90-3-303
[12]	Hesse, B., Diaz, L.A., Snader, C.E., Blackstone, E.H. and Lauer, M.S. (2001) Complete Bundle Branch Block as an Independent Predictor of All-Cause Mortality: Report of 7,073 Patients Referred for Nuclear Exercise Testing. American Journal of Medicine, 110, 253-259. http://dx.doi.org/10.1016/S0002-9343(00)00713-0
[13]	Eriksson, P., Wilhelmsen, L. and Rosengren, A. (2005) Bundle-Branch Block in Middleaged Men: Risk of Complications and Death over 28 Years. The Primary Prevention Study in Goteborg, Sweden. European Heart Journal, 26, 2300-2306. http://dx.doi.org/10.1093/eurheartj/ehi580
[14]	Eriksson, P., Hanson, P.O., Eriksson, H., et al. (1998) Bundle Branch Block in a General Population. Circulation, 98, 2494-2500. http://dx.doi.org/10.1161/01.CIR.98.22.2494
[15]	Fahy, J.G., Pinski, L.S., Miller, P.D., et al. (1996) Natural History of Isolated Bundle Branch Block. American Journal of Cardiology, 77, 1185-1190. http://dx.doi.org/10.1016/S0002-9149(96)00160-9
[16]	Hardason, T., Arnason, A., Eliasson, G.J., et al. (1987) Left Bundle Branch Block: Prevalence, Incidence, Follow-Up and Outcome. European Heart Journal, 8, 1075-1079.
[17]	Kreger, B.E., Anderson, K.M. and Kannel, W.B. (1989) Prevalence of Intraventricular Block in the General Population: The Framingham Study. American Heart Journal, 117, 903-910. http://dx.doi.org/10.1016/0002-8703(89)90630-3
[18]	Haberl, R., Tittus, J., Bohme, E., et al. (2005) Multislice Spiral Computed Tomographic Angiography of Coronary Arteries in Patients with Suspected Coronary Artery Disease: An Effective Filter before Catheter Angiography? American Heart Journal, 149, 1112-1119. http://dx.doi.org/10.1016/j.ahj.2005.02.048
[19]	Goldstein, J.A., Gallagher, M.J., O’Neill, W.W., et al. (2007) A Randomized Controlled Trial of Multi-Slice Coronary Computed Tomography for Evaluation of Acute Chest Pain. Journal of the American College of Cardiology, 49, 863-871. http://dx.doi.org/10.1016/j.jacc.2006.08.064