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Europace Advance Access published online on July 3, 2009
Europace, doi:10.1093/europace/eup181
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

CLINICAL RESEARCH

Long-term mortality predictors in patients with chronic bifascicular block

Julio Marti-Almor*, Merce Cladellas, Victor Bazan, Carmen Altaba, Miguel Guijo, Joaquim Delclos and Jordi Bruguera-Cortada

Cardiology Department, Hospital del Mar, 25-29 Passeig Maritim, Barcelona 08003, Spain

Aims: To evaluate the long-term mortality rate and to determine independent mortality risk factors in patients with bifascicular block (BFB). Patients with BFB are known to have a higher mortality risk than the general population, not only related to progression to atrio-ventricular block but also due to the presence of malignant ventricular arrhythmias. Previous observational and epidemiological studies including a high proportion of patients with structural heart disease have shown an important cardiac mortality rate and may not reflect the real outcome of patients with BFB.

Methods and results: From March 1998 until December 2006, we prospectively studied 259 consecutive BFB patients, 213 (82%) of whom presenting with syncope/pre-syncope, undergoing electrophysiological study. After a median follow-up of 4.5 years (P25:2.16–P75:6.41), 53 patients (20.1%) died, 19 (7%) of whom due to cardiac aetiology. Independent total mortality predictors were age [hazard ratio (HR) 1.04, 95% confidence interval (CI) 1.01–1.09], NYHA class ≥II (HR 2.17, 95% CI 1.05–4.5), atrial fibrillation (HR 2.96, 95% CI 1.1–7.92), and renal dysfunction (HR 4.26, 95% CI 2.04–9.01). An NYHA class of ≥II (HR 5.45, 95% CI 2.01–14.82) and renal failure (HR 3.82, 95% CI 1.21–12.06) were independent predictors of cardiac mortality. No independent predictors of arrhythmic death were found.

Conclusion: Total mortality, especially of cardiac cause, is lower than previously described in BFB patients. Advanced NYHA class and renal failure are predictors of cardiac mortality.

Key Words: Mortality, Bifascicular block, Electrophysiological study

* Corresponding author. Tel: +34 932483489, Fax: +34 932483489, Email: jmarti{at}imas.imim.es

Manuscript submitted 15 April 2009. Accepted after revision 10 June 2009.


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The case of chronic bifascicular block: still a worrying ECG finding?
Europace, September 1, 2009; 11(9): 1140 - 1141.
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