Sudden cardiac death is a major cause of mortality in patients with chronic bifascicular block, frequently associated with underlying coronary disease and ventricular dysrhythmias.
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Risk factors for sudden death in bifascicular block identified; hypothesis-generating and should not yet change practice.
Prospective follow-up studies of 277 patients with chronic bifascicular block showed that 30 patients developed sudden cardiac death (SCD). Cumulative one-, two-, and three-year SCD mortality was computed. The patients that developed SCD were compared with the remaining patients (209 alive and 38 dead). The groups were similar in regard to age, sex, AH, and HV intervals. The following were more frequent in the SCD group (P<.05): angina, previous myocardial infarction, heart failure, cardiomegaly, left bundle-branch block, premature ventricular beats, and ventricular tachycardia. Ventricular fibrillation was the cause of death in four cases of SCD where terminal ECG documentation was available. We concluded that SCD is a major cause of mortality in patients with chronic bifascicular block. The association of SCD with coronary disease and ventricular dysrhythmia suggested ventricular fibrillation as a frequent mechanism. (Arch Intern Med137:1005-1010, 1977)
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P Denes (1977) studied this question.
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