Key result
In patients with bifascicular block, advanced NYHA class (HR 2.17; 95% CI 1.05-4.5) and renal dysfunction (HR 4.26; 95% CI 2.04-9.01) were independent predictors of total mortality.
Cohort (n=259)
Total mortality, especially of cardiac cause, is lower than previously described in BFB patients, with advanced NYHA class and renal failure being independent predictors of cardiac mortality.
May aid risk stratification in bifascicular block; leaves open whether modifying these factors improves survival.
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>or=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 >or=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.
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Martí‐Almor et al. (2009) conducted a cohort in Chronic bifascicular block (n=259). NYHA class >= II was evaluated on Total mortality (HR 2.17, 95% CI 1.05-4.5). In patients with bifascicular block, advanced NYHA class (HR 2.17; 95% CI 1.05-4.5) and renal dysfunction (HR 4.26; 95% CI 2.04-9.01) were independent predictors of total mortality.
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