Long-term prognosis in patients with bifascicular block--the predictive value of noninvasive and invasive assessment
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F Tabrizi1, M Rosenqvist, L Bergfeldt
1Department of Cardiology, Karolinska Institute, South Hospital, Stockholm, Sweden. fariborz.tabrizi@sodersjukhuset.se
Insights
Patients with bifascicular block (BFB) face high mortality. Congestive heart failure (CHF) emerged as the sole independent predictor of mortality and sudden cardiac death (SCD) in this high-risk group.
Area of Science:
- Cardiology
- Electrophysiology
- Clinical Research
Background:
- Bifascicular block (BFB) is associated with increased mortality.
- Identifying high-risk patients within the BFB population is crucial for improved outcomes.
Purpose of the Study:
- To identify high-risk patients with bifascicular block (BFB).
- To evaluate the utility of comprehensive cardiac assessments, including noninvasive and invasive tests, in predicting outcomes in BFB patients.
Main Methods:
- A prospective, population-based study of 100 patients with BFB.
- Investigations included Holter monitoring, exercise testing, echocardiography, and electrophysiological studies.
- Congestive heart failure (CHF) severity was assessed using NYHA classification; NYHA class IV patients were excluded.
Main Results:
- During a median 84-month follow-up, 33 patients died, including 14 from sudden cardiac death (SCD).
- Univariate analysis identified high age, prior myocardial infarction, and CHF as risk factors for mortality and SCD.
- Multivariate Cox regression revealed CHF as the only independent predictor of all-cause mortality and SCD (P < 0.01).
Conclusions:
- Patients with bifascicular block (BFB) have a poor long-term prognosis.
- Noninvasive and invasive investigations have limited predictive value.
- Congestive heart failure (CHF) is the primary independent predictor of mortality and sudden cardiac death (SCD) in BFB patients.
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.
