Korean Circ J.  2019 Jul;49(7):602-611. 10.4070/kcj.2018.0290.

Prognostic Implication of Ventricular Conduction Disturbance Pattern in Hospitalized Patients with Acute Heart Failure Syndrome

• Lee JH
• Park JJ
• Cho Y
• Oh IY
• Yoo BS
• Kim JJ
• Kim KH
• Kang SM
• Baek SH
• Jeon ES
• Cho MC
• Chae SC
• Oh BH
• Choi DJ

• KMID: 2450391
• DOI: http://doi.org/10.4070/kcj.2018.0290

Abstract

BACKGROUND AND OBJECTIVES
Conflicting data exist regarding the prognostic implication of ventricular conduction disturbance pattern in patients with heart failure (HF). This study investigated the prognostic impact of ventricular conduction pattern in hospitalized patients with acute HF.
METHODS
Data from the Korean Acute Heart Failure registry were used. Patients were categorized into four groups: narrow QRS (<120 ms), right bundle branch block (RBBB), left bundle branch block (LBBB), and nonspecific intraventricular conduction delay (NICD). The NICD was defined as prolonged QRS (≥120 ms) without typical features of LBBB or RBBB. The primary endpoint was the composite of all-cause mortality or rehospitalization for HF aggravation within 1 year after discharge.
RESULTS
This study included 5,157 patients. The primary endpoint occurred in 39.7% of study population. The LBBB group showed the highest incidence of primary endpoint followed by NICD, RBBB, and narrow QRS groups (52.5% vs. 49.7% vs. 44.4% vs. 37.5%, p<0.001). In a multivariable Cox-proportional hazards regression analysis, LBBB and NICD were associated with 39% and 28% increased risk for primary endpoint (LBBB hazard ratio [HR], 1.392; 95% confidence interval [CI], 1.152-1.681; NICD HR, 1.278; 95% CI, 1.074-1.520) compared with narrow QRS group. The HR of RBBB for the primary endpoint was 1.103 (95% CI, 0.915-1.329).
CONCLUSIONS
LBBB and NICD were independently associated with an increased risk of 1-year adverse event in hospitalized patients with HF, whereas the prognostic impacts of RBBB were limited. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01389843

Keyword

Cardiac conduction system disease; Bundle branch block; Prognosis; Heart failure

MeSH Terms

Bundle-Branch Block
Heart Failure*
Heart*
Humans
Incidence
Mortality
Prognosis

Figure

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  Figure 1 Flow chart of the patient selection. AIVR = accelerated idioventricular rhythm; CRT = cardiac resynchronization therapy; ECG = electrocardiography; HTPL = heart transplantation; KorAHF = Korean Acute Heart Failure; LBBB = left bundle branch block; NICD = nonspecific intraventricular conduction delay; RBBB = right bundle branch block; VT = ventricular tachycardia.

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  Figure 2 Kaplan-Meier curves for the incidence of study endpoints according to the different ventricular conduction patterns. LBBB = left bundle branch block; NICD = nonspecific intraventricular conduction delay; RBBB = right bundle branch block.

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  Figure 3 Subgroup analysis of the incidence of primary endpoint according to the different ventricular conduction patterns. CI = confidence interval; CKD = chronic kidney disease; EF = ejection fraction; HF = heart failure; HR = hazard ratio; HTN = hypertension; LBBB = left bundle branch block; NICD = nonspecific intraventricular conduction delay; RBBB = right bundle branch block.

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