Circulation, Vol 64, 1265-1271, Copyright © 1981 by American Heart Association
RC Dhingra, E Palileo, B Strasberg, S Swiryn, RA Bauernfeind, CR Wyndham and KM Rosen
In January 1975, we reported results of a prospective follow-up study (mean
538 +/- 42 days) of 119 patients with chronic bifascicular block (BFB), and
concluded that BFB patients with normal and prolonged HV (NHV and PHV) had
a similar incidence of atrioventricular (AV) block and mortality. In this
report, we update these findings in 517 patients with a follow-up of 21
days to 9.8 years (mean 3.4 +/- 0.2 years). Three hundred nineteen patients
(61%) had NHV and 198 (39%) had PHV (greater than 55 msec). The NHV and PHV
groups were similar in regard to age (NHV vs PHV, 61 +/- 1 vs 62 +/- 1
years) and sex (80% male, 20% female vs 82% male and 18% female). The
following were more common (p less than 0.05) in patients with PHV (percent
of patients with finding in NHV vs PHV groups): angina (18% vs 27%),
congestive failure (27% vs 42%), cardiomegaly (48% vs 66%), New York Heart
Association functional class II-IV (34% vs 56%), premature ventricular
complexes (20% vs 29%), and organic heart disease (OHD) (75% vs 85%).
Spontaneous trifascicular block (TFB) developed in two patients (0.6%) with
NHV and nine patients (4.5%) with PHV (p less than 0.05). Cumulative 7-year
incidence of TFB was 3% with NHV and 12% with PHV (p less than 0.01).
Seven-year cumulative cardiovascular mortality was 32% in NHV patients and
57% in PHV patients (p less than 0.005). In conclusion, PHV in patients
with chronic BFB was associated with a greater incidence and severity of
OHD, and higher total and sudden death mortalities. The risk of spontaneous
TFB was small in patients with either NHV or PHV, although it was
significantly higher in the latter.
ARTICLES
Significance of the HV interval in 517 patients with chronic bifascicular block
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