title: Differential clinical characteristics and prognosis of intraventricular conduction defects in patients with chronic heart failure.
abstract: OBJECTIVE
  Intraventricular conduction defects (IVCDs) can impair prognosis of heart failure (HF), but their specific impact is not well established. This study aimed to analyse the clinical profile and outcomes of HF patients with LBBB, right bundle branch block (RBBB), left anterior fascicular block (LAFB), and no IVCDs.
  
  
  RESULTS
  Clinical variables and outcomes after a median follow-up of 21 months were analysed in 1762 patients with chronic HF and LBBB (n = 532), RBBB (n = 134), LAFB (n = 154), and no IVCDs (n = 942). LBBB was associated with more marked LV dilation, depressed LVEF, and mitral valve regurgitation. Patients with RBBB presented overt signs of congestive HF and depressed right ventricular motion. The LAFB group presented intermediate clinical characteristics, and patients with no IVCDs were more often women with less enlarged left ventricles and less depressed LVEF. Death occurred in 332 patients (interannual mortality = 10.8%): cardiovascular in 257, extravascular in 61, and of unknown origin in 14 patients. Cardiac death occurred in 230 (pump failure in 171 and sudden death in 59). An adjusted Cox model showed higher risk of cardiac death and pump failure death in the LBBB and RBBB than in the LAFB and the no IVCD groups.
  
  
  CONCLUSIONS
  LBBB and RBBB are associated with different clinical profiles and both are independent predictors of increased risk of cardiac death in patients with HF. A more favourable prognosis was observed in patients with LAFB and in those free of IVCDs. Further research in HF patients with RBBB is warranted.
authors.affiliation: Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, IIb-Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain. jcinca@santpau.cat
authors.forename: Juan
authors.initials: J
authors.lastname: Cinca
authors.forename: Ana
authors.initials: A
authors.lastname: Mendez
authors.forename: Teresa
authors.initials: T
authors.lastname: Puig
authors.forename: Andreu
authors.initials: A
authors.lastname: Ferrero
authors.forename: Eulalia
authors.initials: E
authors.lastname: Roig
authors.forename: Rafael
authors.initials: R
authors.lastname: Vazquez
authors.forename: Jose R
authors.initials: JR
authors.lastname: Gonzalez-Juanatey
authors.forename: Luis
authors.initials: L
authors.lastname: Alonso-Pulpon
authors.forename: Juan
authors.initials: J
authors.lastname: Delgado
authors.forename: Josep
authors.initials: J
authors.lastname: Brugada
authors.forename: Domingo
authors.initials: D
authors.lastname: Pascual-Figal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002037:Bundle-Branch Block / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D002311:Cardiomyopathy, Dilated / Q000150:complications; D016022:Case-Control Studies; D048909:Diabetes Complications; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications; D010359:Patient Readmission; D011379:Prognosis; D016016:Proportional Hazards Models; D013318:Stroke Volume; D016277:Ventricular Function, Left
keywords: Bundle branch block; Heart failure; Outcomes; Prognosis