title: Effect of bundle branch block patterns on mortality in hospitalized patients with heart failure.
abstract: A widened QRS interval is associated with increased mortality in patients with heart failure (HF). However, the prognostic significance of the type of bundle branch block (BBB) pattern in these patients is unclear. The data of 4,102 patients with HF hospitalized during a prospective national survey were analyzed to investigate the association between BBB type and 1-year mortality in 3,737 patients without pacemakers. Right BBB (RBBB) was present in 381 patients (10.2%) and left BBB (LBBB) in 504 patients (13.5%). RBBB and LBBB were associated with increased 1-year mortality on univariate analysis (odds ratio [OR] 1.44, 95% confidence interval [CI] 1.15 to 1.81, and OR 1.20, 95% CI 0.97 to 1.47, respectively). In patients with systolic HF, after adjusting for multiple risk factors, only RBBB was found to be an independent predictor of mortality (RBBB vs no BBB OR 1.62, 95% CI 1.12 to 2.33, and RBBB vs LBBB OR 1.71, 95% CI 1.09 to 2.69). This correlation was stronger in patients with lower left ventricular ejection fractions and was also maintained in patients without acute myocardial infarctions. Analyzing the data for all patients with HF, there was a trend for increased mortality in the RBBB group only (adjusted OR 1.21, 95% CI 0.94 to 1.56). LBBB was not related to mortality in patients with either systolic HF or preserved ejection fractions. In conclusion, RBBB rather than LBBB is an independent predictor of mortality in hospitalized patients with systolic HF. This prognostic marker could be used for risk stratification and the selection of treatment.
authors.affiliation: Heart Institute, Sheba Medical Center, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. alonyaell@bezeqint.net
authors.forename: Alon
authors.initials: A
authors.lastname: Barsheshet
authors.forename: Jonathan
authors.initials: J
authors.lastname: Leor
authors.forename: Uri
authors.initials: U
authors.lastname: Goldbourt
authors.forename: Moshe
authors.initials: M
authors.lastname: Garty
authors.forename: Roseline
authors.initials: R
authors.lastname: Schwartz
authors.forename: Solomon
authors.initials: S
authors.lastname: Behar
authors.forename: David
authors.initials: D
authors.lastname: Luria
authors.forename: Michael
authors.initials: M
authors.lastname: Eldar
authors.forename: Michael
authors.initials: M
authors.lastname: Glikson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002037:Bundle-Branch Block / Q000401:mortality*; D016009:Chi-Square Distribution; D005260:Female; D006333:Heart Failure / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D016019:Survival Analysis