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European Heart Journal 2002 23(21):1692-1698; doi:10.1053/euhj.2001.3157
Copyright © 2002 by the European Society of Cardiology.
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Cumulative effect of complete left bundle-branch block and chronic atrial fibrillation on 1-year mortality and hospitalization in patients with congestive heart failure. A report from the Italian network on congestive heart failure (in-CHF database)

S. Baldasseronia, L. De Biaseb, C. Frescoc, N. Marchionnid, M. Marinia, G. Masottid, G. Orsinia, M. Porcue, F. Pozzarf, M. Scherillog and A.P. Maggionia,f1

a Italian Association of Hospital Cardiologists (ANMCO) Research Center, Florence, Italy
b S. Andrea Hospital, Department of Cardiology, Rome, Italy
c S.M. Misericordia Hospital, Department of Cardiology, Udine, Italy
d Department of Critical Care Medicine and Surgery, Section of Gerontology and Geriatric Medicine, University of Florence, Azienda Ospedaliera Gareggi, Florence, Italy
e S. Michele Brotzu Hospital, Department of Cardiology, Cagliari, Italy
f S. Camillo Hospital, Department of Cardiology, Rome, Italy
g Monaldi Hospital, Department of Cardiology, Naples, Italy

revised December 19, 2001; accepted December 19, 2001

Abstract

Background Many clinical variables have been proposed as prognostic factors in patients with congestive heart failure. Among these, complete left bundle-branch block and atrial fibrillation are known to impair significantly left ventricular performance in patients with congestive heart failure. However, their combined effect on mortality has been poorly investigated. The aim of this study was to determine whether left bundle-branch block associated with atrial fibrillation had an independent, cumulative effect on mortality for congestive heart failure.

Methods and Results We analysed the Italian Network on congestive heart failure (IN-CHF) Registry that was established by the Italian Association of Hospital Cardiologists in 1995. One-year follow-up data were available for 5517 patients. Complete left bundle-branch block and atrial fibrillation were associated in 185 (3·3%) patients. In this population the cause of congestive heart failure was dilated cardiomyopathy (38·4%), ischaemic heart disease (35·1%), hypertensive heart disease (17·3%), and other aetiologies (9·2%). This combination of electrical defects was associated with an increased 1-year mortality from any cause (hazard ratio, HR: 1·88; 95% CI 1·37–2·57) and sudden death (HR: 1·89; 95% CI 1·17–3·03) and 1-year hospitalization rate (HR: 1·83; 95% CI 1·26–2·67).

Conclusions In patients with congestive heart failure, the contemporary presence of left bundle-branch block and atrial fibrillation was associated with a significant increase in mortality. This synergistic effect remained significant after adjusting for clinical variables usually associated with advanced heart failure. We can conclude that this combination of electrical disturbances identifies a congestive heart failure specific population with a high risk of mortality. Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved

Key Words: Congestive heart failure, atrial fibrillation, complete left bundle branch-block, prognosis

f1 Correspondence: Aldo P. Maggioni, MD, ANMCO Research Center, Via La Marmora 34, 50121 Florence, Italy.

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