Bundle branch block during primary angioplasty : reperfusion success remains encrypted in the ECG !

It has been known for years that the finding of bundle branch block (BBB) in patients with ST-segment elevation myocardial infarction (STEMI) is associated with a high mortality rate [1]. In the prethrombolytic era, several studies demonstrated that the presence of left BBB (LBBB) and right BBB (RBBB) was associated with large infarct sizes often accompanied by heart failure, ventricular arrhythmias or cardiovascular death [2]. Although thrombolytic reperfusion decreased mortality in STEMI patients, the appearance of BBB was still associated with a poor shortand long-term prognosis [3–6]. Current guidelines recommend primary percutaneous coronary intervention (PCI) as the goldstandard therapy for the management of patients with STEMI [7–9]. There are some reports addressing the incidence and prognosis of BBB in this setting, but hardly anyone addresses the importance of different kinds of BBB; is it the same as a previous (already known) BBB or a de novo (transient vs persistent after reperfusion) BBB?