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. 2013 Aug;15(8):877-84.
doi: 10.1093/eurjhf/hft042. Epub 2013 Mar 19.

Differential clinical characteristics and prognosis of intraventricular conduction defects in patients with chronic heart failure

Juan Cinca  1 , Ana Mendez, Teresa Puig, Andreu Ferrero, Eulalia Roig, Rafael Vazquez, Jose R Gonzalez-Juanatey, Luis Alonso-Pulpon, Juan Delgado, Josep Brugada, Domingo Pascual-Figal; investigators of the Spanish Heart Failure Network (REDINSCOR)
Collaborators, Affiliations

Differential clinical characteristics and prognosis of intraventricular conduction defects in patients with chronic heart failure

Juan Cinca et al. Eur J Heart Fail. 2013 Aug.

Abstract

Aims: Intraventricular conduction defects (IVCDs) can impair prognosis of heart failure (HF), but their specific impact is not well established. This study aimed to analyse the clinical profile and outcomes of HF patients with LBBB, right bundle branch block (RBBB), left anterior fascicular block (LAFB), and no IVCDs.

Methods and results: Clinical variables and outcomes after a median follow-up of 21 months were analysed in 1762 patients with chronic HF and LBBB (n = 532), RBBB (n = 134), LAFB (n = 154), and no IVCDs (n = 942). LBBB was associated with more marked LV dilation, depressed LVEF, and mitral valve regurgitation. Patients with RBBB presented overt signs of congestive HF and depressed right ventricular motion. The LAFB group presented intermediate clinical characteristics, and patients with no IVCDs were more often women with less enlarged left ventricles and less depressed LVEF. Death occurred in 332 patients (interannual mortality = 10.8%): cardiovascular in 257, extravascular in 61, and of unknown origin in 14 patients. Cardiac death occurred in 230 (pump failure in 171 and sudden death in 59). An adjusted Cox model showed higher risk of cardiac death and pump failure death in the LBBB and RBBB than in the LAFB and the no IVCD groups.

Conclusion: LBBB and RBBB are associated with different clinical profiles and both are independent predictors of increased risk of cardiac death in patients with HF. A more favourable prognosis was observed in patients with LAFB and in those free of IVCDs. Further research in HF patients with RBBB is warranted.

Keywords: Bundle branch block; Heart failure; Outcomes; Prognosis.

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Figures

Figure 1
Figure 1
Adjusted Cox model survival curves for readmissions (A), cardiac death (B), and pump failure death (C) in patients with chronic heart failure with and without intraventricular conduction defects (IVCDs) after a median follow-up of 21 months. LAFB, left anterior fascicular block; LBBB, left bundle branch block; RBBB, right bundle branch block.
See this image and copyright information in PMC

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