Long-term mortality predictors in patients with chronic bifascicular block

Abstract

AimsTo 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 resultsFrom 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 ≥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 ≥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.ConclusionTotal mortality, especially of cardiac cause, is lower than previously described in BFB patients. Advanced NYHA class and renal failure are predictors of cardiac mortality.