European Heart Journal Advance Access originally published online on July 31, 2007
European Heart Journal 2007 28(20):2449-2455; doi:10.1093/eurheartj/ehm262
Influence of left bundle branch block on long-term mortality in a population with heart failure
1 Department of Cardiology, Karolinska University Hospital, Karolinska Institutet, S-141 86 Stockholm, Sweden
2 Department of Cardiology, Örebro University Hospital, Örebro, Sweden
3 Department of Cardiology, Karolinska Institute, South Hospital, Stockholm, Sweden
4 Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden
5 Department of Cardiology, University Hospital, Linköping, Sweden
Received 17 October 2006; revised 11 May 2007; accepted 31 May 2007; online publish-ahead-of-print 31 July 2007.
* Corresponding author. Tel: +46 85 858 1733; fax: +46 85 858 6710. E-mail address: fariborz.tabrizi{at}karolinska.se
Background: The purpose of this study was to assess the independent contribution of left bundle branch block (LBBB) on long-term mortality in a large cohort with symptomatic heart failure (HF) requiring hospitalization.
Methods and Results: We studied a prospective cohort of 21 685 cases of symptomatic HF requiring hospitalization in the Register of Information and Knowledge about Swedish Heart Intensive care Admissions in 1995–2003. Long-term mortality was evaluated by Logistic regression analysis, adjusted for multiple covariates that could influence long-term prognosis. LBBB was present in 20% (4395 of 21 685) of HF admissions. Patients with LBBB had a higher prevalence of cardiac comorbid conditions than patients with no LBBB. 1-, 5-, and 10-year mortality was 31.5 vs. 28.4%, 69.3 vs. 61.3%, and 90.1 vs. 84.7% for HF patients with and without respectively LBBB. When adjusting for comorbidity, LBBB was associated with increased 5-year mortality (OR, 1.21; 95% CI, 1.10–1.35; P < 0.001). When left ventricular ejection fraction was included in the analysis LBBB had no longer any independent influence on 5-mortality (OR, 0.99; 95% CI, 0.62–1.56; P = 0.953).
Conclusion: LBBB occurs in 1/5 in HF patients requiring hospitalization and is associated with a very high mortality. However, the high long-term mortality appears to be caused by cardiac comorbidities and myocardial dysfunction rather than the LBBB per se.
Key Words: Heart failure • Bundle branch block • Prognosis
These authors have contributed equally to the manuscript.
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