Long-term prognosis in patients with bifascicular block--the predictive value of noninvasive and invasive assessment

• OBJECTIVES: Patients with bifascicular block (BFB) have a high mortality rate. The purpose of the present study was to identify high-risk patients in a BFB population by performing an extensive cardiac evaluation including noninvasive and invasive tests. DESIGN: Population-based study. SUBJECTS: A total of 100 patients with BFB, of whom 41 had a history of unexplained syncope, were prospectively studied. The mean age was 68 +/- 12. All patients were investigated with Holter-monitoring, an exercise test, an echocardiography, and an invasive electrophysiological study. The severity of congestive heart failure (CHF) was assessed by New York Heart Association (NYHA) classification. Patients in NYHA class IV were excluded. INTERVENTIONS: Patients with syncope were recommended prophylactic pacemaker treatment, which was accepted by 31 patients (76%). Main outcome measures. All-cause mortality and sudden cardiac death (SCD). RESULTS: During a median follow-up of 84 months, 33 patients died, of whom 14 in SCD. In a univariate analysis, high age, a previous myocardial infarction, and CHF were associated with a significantly increased risk of all-cause mortality and SCD. In a Cox multiple regression analysis, CHF was the only independent predictor of all-cause mortality and SCD (P < 0.01). CONCLUSION: Patients with BFB have a poor long-term prognosis. The predictive value of noninvasive and invasive investigations is limited. The only independent predictor of all-cause mortality and SCD in this population was the presence of CHF.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kardiologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

Nyckelord

Aged

Aged

80 and over

Bundle-Branch Block/*diagnosis/physiopathology/therapy

Cardiac Pacing

Artificial

Chronic Disease

Death

Sudden

Cardiac/etiology

Electrocardiography

Ambulatory

Epidemiologic Methods

Exercise Test

Female

Heart Failure

Congestive/complications

Humans

Male

Middle Aged

Prognosis

Syncope/etiology/therapy

MEDICINE

Cardiology

Cardiology

Publikations- och innehållstyp

ref (ämneskategori)

art (ämneskategori)