16 February 2025
: Case report
Right Bundle Branch Block on ECG as a Predictor of Sudden Cardiac Arrest Due to Pulmonary Embolism
Unusual clinical course, Challenging differential diagnosis, Management of emergency care
Chunliang Wang
DOI: 10.12659/AJCR.946074
Am J Case Rep 2025; 26:e946074
Abstract
BACKGROUND: High-risk pulmonary embolism (PE) refers to a subset of massive PE that can lead to sudden cardiac arrest (SCA) or hemodynamic collapse. It is crucial to identify the clues that might precede high-risk PE in resuscitated SCA. The presence of right bundle branch block (RBBB) with a QR pattern in V1 on the electrocardiogram (ECG) has a high positive predictive value for diagnosing cardiac arrest caused by high-risk PE. Therefore, we present a case study of SCA caused by high-risk PE.
CASE REPORT: A 44-year-old woman with no medical history presented to the emergency room due to SCA. The first ECG showed sinus tachycardia and RBBB with a QR pattern in V1. The clinical manifestations, particularly the abnormal ECG findings, led to the consideration of high-risk PE. Urgent thrombolytic therapy was administered before confirmation with computed tomographic pulmonary angiogram (CTPA). The patient was eventually diagnosed with antiphospholipid antibody syndrome and treated with warfarin.
CONCLUSIONS: RBBB with a QR pattern in V1 on ECG has a high positive predictive value for the diagnosis of cardiac arrest caused by high-risk PE. Furthermore, the presence of a QR pattern in V1 performs as an independent predictor for high-risk PE patients who may require advanced treatments, including systemic thrombolysis or invasive embolectomy. It is worth further exploring the prioritization of thrombolysis for high-risk PE patients before confirmation with CTPA, when ECG findings strongly suggest the diagnosis.
Keywords: Electrocardiography, Pulmonary Embolism, Case Reports, Heart Arrest
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