title: Cardiovascular outcomes in patients with intraventricular conduction blocks: A sixteen-year follow-up in a state-wide database.
abstract: BACKGROUND
  To assess the adverse clinical effects of left anterior hemiblock alone or in combination with right bundle branch block and of complete left bundle branch block in comparison with isolated right bundle branch block and the relationship of these effects with altered mechanoelectric factors resulting in left ventricular dysfunction.
  
  
  METHODS
  In a 16-year follow-up study using a statewide database, we studied the occurrence of mortal and morbid cardiovascular (CV) events among patients without apparent ischemic heart disease who had left anterior hemiblock (LAHB, n=4273, right bundle branch block (RBBB) with LAHB (BFBB, n=1857) and left bundle branch block (LBBB, n=9484 compared to isolated RBBB (n=25288).
  
  
  RESULTS
  After adjustment for demographics, co-morbidities and insurance, LAHB was associated with a significant excess risk of all-cause death (HR 1.134, 95% CI 1.061-1.213, p=0.0002) and CV death (HR 1.329, 95% CI 1.174-1.501, p<0.0001). BFBB was associated with excess HF (HR 1.190, 95% CI 1.048-1.351, p<0.0071), all-cause death (HR 1.440, 95% CI 1.045-1.252, p=0.0036) and CV death (HR 1.210, 95% CI 1.020-1.436, p<0.0001). LBBB was associated with an excess risk of MR (HR 1.307, 95% CI 1.116-1.530, p<0.0009), HF 1.177, 95% CI1.097-1.263, p<0.0001) and CV death (HR 1.220, 95% CI 1.106-1.345, p<0.0001).
  
  
  CONCLUSIONS
  In patients without apparent ischemic heart disease, the presence of LAHB alone or in combination with RBBB imparts increased risk of CV and all-cause death compared to isolated RBBB. BFBB is also associated with an increased risk of HF.
authors.affiliation: Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA. Electronic address: jpantazopoulos@gmail.com.
authors.forename: John S
authors.initials: JS
authors.lastname: Pantazopoulos
authors.affiliation: Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
authors.forename: Alice
authors.initials: A
authors.lastname: David
authors.affiliation: Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
authors.forename: William J
authors.initials: WJ
authors.lastname: Kostis
authors.affiliation: Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
authors.forename: Nora M
authors.initials: NM
authors.lastname: Cosgrove
authors.affiliation: Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
authors.forename: John B
authors.initials: JB
authors.lastname: Kostis
authors.affiliation: Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002037:Bundle-Branch Block / Q000150:complications / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology*; D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology / Q000208:ethnology / Q000401:mortality*; D002319:Cardiovascular System / Q000503:physiopathology*; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000401:mortality; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*
keywords: Atrial fibrillation; Cardiovascular death; Heart failure; Intraventricular blocks; Mitral regurgitation; Mortality