One hundred and forty-one survivors of intracardiac repair of tetralogy of Fallot (TOF), operated on between 1958 and 1972, were studied in order to document the incidence of right bundle branch block and left anterio...
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One hundred and forty-one survivors of intracardiac repair of tetralogy of Fallot (TOF), operated on between 1958 and 1972, were studied in order to document the incidence of right bundle branch block and left anterior hemiblock (RBBB and LAH) and to define the late prognosis. RBBB and LAH occurred in 31 patients (22 per cent), all of whom have had complete follow-up. Transient complete heart block (CHB) occurred postoperatively in 2 patients; there were no other significant arrhythmias. Two late deaths have occurred, neither from arrhythmia (one from progressive congestive heart failure, and the other from attempted reclosure of a ventricular septal defect). The remainder of the patients are well an average of 76 months postoperatively (range, 144 to 12 months). The absence of late-onset CHB or sudden death in this series contrasts with relatively high incidence of these events in some studies of RBBB and LAH after intracardiac repair of TOF. However, in those reports a history of transient postoperative CHB (indicative of trifascicular disease in this setting) can be found in 75 per cent of those who developed late-onset CHB or died suddenly. We conclude that the occurrence of RBBB and LAH after intracardiac repair of TOF does not of itself carry a bad late prognosis. The critical factor in a bad late prognosis in patients with ECG evidence of RBBB and LAH may be the history of transient postoperative CHB.
Background and Objectives It has been suggested that prolongation of the QRS duration (> 120 ms) is an independent risk factor for mortality in patients with cardiomyopathy. The purpose of this study was to examine...
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Background and Objectives It has been suggested that prolongation of the QRS duration (> 120 ms) is an independent risk factor for mortality in patients with cardiomyopathy. The purpose of this study was to examine the association between QRS duration and survival in patients with heart failure. Methods We performed a retrospective analysis to examine the association between QRS prolongation ( 120 ms) and mortality. The study population included 669 patients with heart failure. Two groups, on the basis of baseline QRS duration < 120 milliseconds or 120 milliseconds, were identified. The groups were compared with respect to total mortality and sudden death. Subgroups were also stratified by right bundle branch block and left bundle branch block, ejection fraction (EF) <30% and greater than or equal to30% to 40%, ischemic and nonischemic cardiomyopathy, amiodarone and placebo. Results Prolonged QRS was associated with a significant increase in mortality (49.3% vs 34.0%, P = .0001) and sudden death (24.8%, vs 17.4%, P = .0004). Left bundle branch block was associated with worse survival (P = .006) but not sudden death. In patients with an EF <30%, QRS prolongation continued to be associated with a significant increase in mortality (51.6% vs 41.1%, P = .01) and sudden death (28.8% vs 21.1%, P = .02). In those with an EF of 30% to 40%, QRS prolongation was associated with a significant increase in mortality (42.7% vs 23.3%, P = .0036) but not in sudden death (13.3% vs 12.0%, P = .625). After adjustment for baseline variables, independent predictors of mortality were found to be prolongation of QRS (P = .0028, risk ratio 1.46) and depressed EF (P = .0001, risk ratio 0.965). Age, type of cardiomyopathy, and drug treatment group were not predictive of mortality. Conclusion QRS prolongation is an independent predictor of both increased total mortality and sudden death in patients with heart failure.
Background A deleterious effect of complete left bundle-branch block (LBBB) on left ventricular function has been established. Nevertheless, the independent effect of a widened QRS on mortality rate in congestive hear...
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Background A deleterious effect of complete left bundle-branch block (LBBB) on left ventricular function has been established. Nevertheless, the independent effect of a widened QRS on mortality rate in congestive heart failure (CHF) is still controversial. Therefore, we carried out this analysis to determine whether LBBB is an independent predictor of mortality in CHF. Methods and Results We analyzed the large Italian Network on CHF Registry of unselected outpatients with CHF of different causes. The registry was established by the Italian Association of Hospital Cardiologists in 1995. Complete 1-year follow-up data were available for 5517 patients. The main underlying cardiac diagnosis was ischemic heart disease in 25 12 patients (45.6%), dilated cardiomyopathy in 1988 patients (36.0%), and hypertensive heart disease in 714 patients (12.9%). Other causes were recorded in the remaining 303 cases (5.5%). LBBB was present in 1391 patients (25.2%) and was associated with an increased 1-year mortality rate from any cause (hazard ratio, 1.70;95% confidence interval, 1.41 to 2.05) and sudden death (hazard ratio, 1.58;95% confidence interval, 1.21 to 2.06). Multivariate analysis showed that such an increased risk was still significant after adjusting for age, underlying cardiac disease, indicators of CHF severity, and prescription of angiotensin-converting enzyme inhibitors and beta-blockers. Conclusion LBBB is an unfavorable prognostic marker in patients with CHF. The negative effect is independent of age, CHF severity, and drug prescriptions. These data may support the rationale of randomized trials to verify the effects on mortality rate of ventricular resynchronization with multisite cardiac pacing in patients with CHF and LBBB.
The Brugada syndrome is a hereditary disease causing sudden cardiac death in apparently healthy individuals with a structurally normal heart. The disease is caused by mutations in the cardiac sodium channel gene SCN5A...
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