Ventricular conduction abnormalities as predictors of long-term survival in acute de novo and decompensated chronic heart failure.

Aims: Data on the prognostic role of left and right bundle branch blocks (LBBB and RBBB), and nonspecific intraventricular conduction delay (IVCD; QRS ≥ 110 ms, no BBB) in acute heart failure (AHF) are controversial. Our aim was to investigate electrocardiographic predictors of long-term survival in patients with AHF and acutely decompensated chronic heart failure (ADCHF).

Methods And Results: We analysed the admission electrocardiogram of 982 patients from a multicenter European cohort of AHF with 3.9 years' mean follow-up. Half (51.5%,  = 506) of the patients had AHF. LBBB, and IVCD were more common in ADCHF than in AHF: 17.2% vs. 8.7% ( < 0.001) and 20.6% vs. 13.2% ( = 0.001), respectively, and RBBB was almost equally common (6.9% and 8.1%;  = 0.5), respectively. Mortality during the follow-up was higher in patients with RBBB (85.4%) and IVCD (73.7%) compared with patients with normal ventricular conduction (57.0%);  < 0.001 for both. The impact of RBBB on prognosis was prominent in AHF (adjusted HR 1.93, 1.03-3.60;  = 0.04), and IVCD independently predicted death in ADCHF (adjusted HR 1.79, 1.28-2.52;  = 0.001). Both findings were pronounced in patients with reduced ejection fraction. LBBB showed no association with increased mortality in either of the subgroups. The main results were confirmed in a validation cohort of 1511 AHF patients with 5.9 years' mean follow-up.

Conclusions: Conduction abnormalities predict long-term survival differently in AHF and ADCHF. RBBB predicts mortality in AHF, and IVCD in ADCHF. LBBB has no additive predictive value in AHF requiring hospitalization.