Right bundle branch block: Prevalence, incidence, and cardiovascular morbidity and mortality in the general
M Alventosa-Zaidin1, L Guix Font2, M Benitez Camps3
1a Centre d'Atenció Primària Arenys de Mar, Servei d'atenció Primària Barcelonès Nord- Maresme, Institut Català de la Salut , Barcelona , Spain.
Insights
Right bundle branch block (RBBB) affects 8% of the general population, particularly men and the elderly. While complete RBBB is linked to increased mortality and cardiovascular events, only bifascicular block showed statistical significance. Incomplete RBBB progression to complete RBBB indicated higher risks.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Right bundle branch block (RBBB) is a frequent electrocardiogram (ECG) finding.
- Understanding its prevalence and prognostic implications in the general population is crucial.
Purpose of the Study:
- To determine the prevalence and incidence of RBBB in individuals without prior cardiovascular events (CVE).
- To assess if RBBB increases cardiovascular morbidity and mortality compared to a normal ECG.
Main Methods:
- A historical cohort study involving 2981 participants from primary health centers.
- Cox and logistic regression analyses were used to evaluate associations with RBBB and CVE.
Main Results:
- Overall RBBB prevalence was 8%, higher in men and older individuals.
- Complete RBBB (cRBBB) was associated with increased all-cause mortality and CVE, though only bifascicular block (BFB) reached statistical significance after adjustment.
- Progression from incomplete RBBB (iRBBB) to cRBBB correlated with higher incidence of heart failure and chronic kidney disease.
Conclusions:
- RBBB is common in the general population, with prevalence varying by sex and age.
- While cRBBB suggests increased risk, BFB is the most significant predictor.
- Progression of iRBBB to cRBBB signals heightened risk for cardiovascular events.
Abstract:
Background: Right bundle branch block (RBBB) is among the most common electrocardiographic abnormalities. Objectives: To establish the prevalence and incidence of RBBB in the general population without cardiovascular events (CVE) and whether RBBB increases cardiovascular morbidity and mortality compared with patients with a normal electrocardiogram (ECG). Methods: A historical study of two cohorts including 2981 patients from 29 primary health centres without baseline CVE. Cox (for CVE) and logistic (for cardiovascular factors) regression was used to assess their association with RBBB. Results: Of the patients (58% women; mean age 65.9), 92.2% had a normal ECG, 4.6% incomplete RBBB (iRBBB) and 3.2% complete RBBB (cRBBB). Mean follow-up was five years. Factors associated with appearance of cRBBB were male sex (HR = 3.8; 95%CI: 2.4-6.1) and age (HR = 1.05 per year; 95%CI: 1.03-1.08). In a univariate analysis, cRBBB was associated with an increase in all-cause mortality but only bifascicular block (BFB) was significant after adjusting for confounders. cRBBB tended to increase CVE but the results were not statistically significant. Presence of iRBBB was not associated with adverse outcomes. Patients with iRBBB who progressed to cRBBB showed a higher incidence of heart failure and chronic kidney disease. Conclusion: In this general population cohort with no CV disease, 8% had RBBB, with a higher prevalence among men and elderly patients. Although all-cause mortality and CVE tended to increase in the presence of cRBBB, only BFB showed a statistically significant association with cRBBB. Patients with iRBBB who progressed to cRBBB had a higher incidence of CVE. We detected no effect of iRBBB on morbidity and mortality.
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