Article

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.

Langue : ANGLAIS