title: Long-term prognosis in patients with bifascicular block--the predictive value of noninvasive and invasive assessment.
abstract: OBJECTIVE
  Patients with bifascicular block (BFB) have a high mortality rate. The purpose of the present study was to identify high-risk patients in a BFB population by performing an extensive cardiac evaluation including noninvasive and invasive tests.
  
  
  METHODS
  Population-based study.
  
  
  METHODS
  A total of 100 patients with BFB, of whom 41 had a history of unexplained syncope, were prospectively studied. The mean age was 68 +/- 12. All patients were investigated with Holter-monitoring, an exercise test, an echocardiography, and an invasive electrophysiological study. The severity of congestive heart failure (CHF) was assessed by New York Heart Association (NYHA) classification. Patients in NYHA class IV were excluded.
  
  
  METHODS
  Patients with syncope were recommended prophylactic pacemaker treatment, which was accepted by 31 patients (76%). Main outcome measures. All-cause mortality and sudden cardiac death (SCD).
  
  
  RESULTS
  During a median follow-up of 84 months, 33 patients died, of whom 14 in SCD. In a univariate analysis, high age, a previous myocardial infarction, and CHF were associated with a significantly increased risk of all-cause mortality and SCD. In a Cox multiple regression analysis, CHF was the only independent predictor of all-cause mortality and SCD (P < 0.01).
  
  
  CONCLUSIONS
  Patients with BFB have a poor long-term prognosis. The predictive value of noninvasive and invasive investigations is limited. The only independent predictor of all-cause mortality and SCD in this population was the presence of CHF.
authors.affiliation: Department of Cardiology, Karolinska Institute, South Hospital, Stockholm, Sweden. fariborz.tabrizi@sodersjukhuset.se
authors.forename: F
authors.initials: F
authors.lastname: Tabrizi
authors.forename: M
authors.initials: M
authors.lastname: Rosenqvist
authors.forename: L
authors.initials: L
authors.lastname: Bergfeldt
authors.forename: A
authors.initials: A
authors.lastname: Englund
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002037:Bundle-Branch Block / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D002304:Cardiac Pacing, Artificial; D002908:Chronic Disease; D016757:Death, Sudden, Cardiac / Q000209:etiology; D015716:Electrocardiography, Ambulatory; D004812:Epidemiologic Methods; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013575:Syncope / Q000209:etiology / Q000628:therapy