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Published on: December 11, 2017
The prevalence and incidence of left bundle branch block in ambulant patients with chronic heart failure
Andrew L Clark1, Kevin Goode, John G F Cleland
1Department of Academic Cardiology, Castle Hill Hospital, Castle Road, Cottingham, Hull, UK. HU16 5JQ, UK. a.l.clark@hull.ac.uk
Insights
Left bundle branch block (LBBB) affects one-third of heart failure patients. New LBBB is an independent adverse prognostic indicator, highlighting the need for regular ECG monitoring in chronic heart failure care.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Left bundle branch block (LBBB) is prevalent in approximately one-third of patients diagnosed with chronic heart failure.
- The presence of LBBB on a 12-lead electrocardiogram (ECG) in heart failure patients warrants further investigation due to its potential prognostic implications.
Purpose of the Study:
- To determine the incidence of new-onset LBBB in ambulatory patients with chronic stable heart failure.
- To evaluate the prognostic significance of baseline LBBB and incident LBBB in this patient population.
Main Methods:
- A cohort of 1418 consecutive patients with chronic heart failure were analyzed, with baseline 12-lead ECGs recorded.
- Follow-up ECGs were obtained for a subset of patients (52%) at one year to assess changes in QRS duration and the incidence of LBBB.
- Statistical analysis was performed to identify predictors of incident LBBB and its association with patient outcomes.
Main Results:
- The incidence of new LBBB in the first year was 10.9%.
- Baseline QRS duration and amiodarone use were the sole predictors of incident LBBB.
- New LBBB was identified as an independent adverse prognostic factor, associated with a significantly worse outcome (HR 2.09).
Conclusions:
- The crude incidence of LBBB is 10.9% within the first year in an unselected group of outpatients with chronic stable heart failure.
- Regular 12-lead ECG monitoring should be an integral part of ongoing care for patients with chronic heart failure to detect new LBBB.
- The development of new LBBB signifies a worse prognosis and necessitates close clinical attention.
Background:
Approximately one third of patients with chronic heart failure have left bundle branch block (LBBB) on their 12-lead ECG.
Methods And Results:
1418 consecutive patients (average (SD) age 70.5 (10.4) years; 74% male) first seen in a community heart failure clinic between December 2001 and June 2006 had a 12 lead electrocardiogram (ECG). 485 (34%) had a QRS duration >or=120 ms. Patients with a broad QRS were older (72.2 v 69.3 years), had worse left ventricular systolic function, were on a higher daily dose of diuretic and were more likely to be on amiodarone (14.4 v 7.1%). 12 lead ECG was available for 734 patients (52%) at 1 year follow up. The QRS interval increased from 115.1 ms at baseline to 117.6 (P<0.0001). There were 52 incident cases of LBBB, an incidence of 10.9%. The only predictors of incident LBBB were QRS duration at baseline and amiodarone use at baseline. The proportion of patients with LBBB increased from 34.0% at baseline to 36.7%, 37.7% and 42.3% at 1, 2 and 3 years follow up, respectively. Baseline LBBB was associated with a worse outcome (HR 1.25 (95% CI 1.01-1.55). New LBBB was an independent adverse prognostic feature (HR 2.09 (95% CI 1.17-3.73); P=0.013).
Conclusions:
The crude incidence of LBBB is 10.9% in the first year of follow up in an unselected population of ambulatory outpatients with chronic stable heart failure. Ongoing care of patients with chronic heart failure should include a regular 12 lead electrocardiogram.
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