You are here

Article Text

Article menu

Download PDFPDF

Cardiac risk factors and prevention
Original research article
Clinical implications of electrocardiographic bundle branch block in primary care
Free
  1. Peter Vibe Rasmussen1,2,
  2. Morten Wagner Skov2,3,
  3. Jonas Ghouse2,3,
  4. Adrian Pietersen4,
  5. Steen Møller Hansen5,
  6. Christian Torp-Pedersen5,6,
  7. Lars Køber3,7,
  8. Stig Haunsø2,3,7,
  9. Morten Salling Olesen2,8,
  10. Jesper Hastrup Svendsen3,7,
  11. Jacob Melgaard6,
  12. Claus Graff6,
  13. Anders Gaardsdal Holst3,9,
  14. Jonas Bille Nielsen2,10,11
  1. 1 Department of Cardiology, Herlev-Gentofte Hospital, Hellerup, Denmark
  2. 2 Laboratory for Molecular Cardiology, University Hospital Copenhagen, Rigshospitalet, Copenhagen, Denmark
  3. 3 Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
  4. 4 Copenhagen General Practitioners' Laboratory, Copenhagen, Denmark
  5. 5 Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
  6. 6 Department of Health Science and Technology, University of Aalborg, Aalborg, Denmark
  7. 7 Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen
  8. 8 Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
  9. 9 Novo Nordisk A/S, Denmark
  10. 10 Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
  11. 11 Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
  1. Correspondence to Peter Vibe Rasmussen, Department of Cardiology, Herlev-Gentofte Hospital, Hellerup, Denmark ; peter.vibe.rasmussen{at}gmail.com

Abstract

Objectives Electrocardiographic bundle branch block (BBB) is common but the prognostic implications in primary care are unclear. We sought to investigate the relationship between electrocardiographic BBB subtypes and the risk of cardiovascular (CV) outcomes in a primary care population free of major CV disease.

Methods Retrospective cohort study of primary care patients referred for electrocardiogram (ECG) recording between 2001 and 2011. Cox regression models were used to estimate hazard ratios (HR) as well as absolute risks of CV outcomes based on various BBB subtypes.

Results We included 202 268 individuals with a median follow-up period of 7.8 years (Inter-quartile range [IQR] 4.9–10.6). Left bundle branch block (LBBB) was associated with heart failure (HF) in both men (HR 3.96, 95% CI 3.30 to 4.76) and women (HR 2.51, 95% CI 2.15 to 2.94) and with CV death in men (HR 1.80, 95% CI 1.38 to 2.35). Right bundle branch block (RBBB) was associated with pacemaker implantation in both men (HR 3.26, 95% CI 2.74 to 3.89) and women (HR 3.69, 95% CI 2.91 to 4.67), HF in both sexes and weakly associated with CV death in men. Regarding LBBB, we found an increasing hazard of HF with increasing QRS-interval duration (HR 1.25, 95% CI 1.11 to 1.42 per 10 ms increase in men and HR 1.23, 95% CI 1.08 to 1.40 per 10 ms increase in women). Absolute 10-year risk predictions across age-specific and sex-specific subgroups revealed clinically relevant differences between having various BBB subtypes.

Conclusions Opportunistic findings of BBB subtypes in primary care patients without major CV disease should be considered warnings of future HF and pacemaker implantation.

  • electrocardiography
  • heart failure
  • pacemakers
  • cardiac risk factors and prevention

https://doi.org/10.1136/heartjnl-2018-314295

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • PVR and MWS contributed equally.

    • Contributors Study concept and design were determined by: PVR, JBN, MWS, AGH. Acquisition of data was performed by: CG, AHP, JBN. Digital ECG analysis was performed by: PVR,JBN, CG, JM. Drafting of the manuscript was carried out by: PVR, MWS, JBN. Critical revision of the manuscript for important intellectual content was carried out by: JBN, MWS, JG, CG, AHP, MSO, SH, JHS, LK, JM, SH, CT-P, LK, AGH. Statistical analysis and data interpretation were performed by: PVR, MWS, JBN, JG. Fund raising was performed by: JBN, CG, SH, AGH.

    • Funding This study was supported by The Research Committee of Rigshospitalet and The John and Birthe Meyer Foundation. JBN was supported by the Danish Heart Foundation (16-R107-A6779), the Lundbeck Foundation (R220-2016-1434), the AP Møller Foundation for the Advancement of Medical Science and Fondsbørsvekselerer Henry Hansen og Hustru Karla Hansen Født Vestergaards Legat.

    • Competing interests AGH is an employee of Novo Nordisk A/S.

    • Ethics approval Due to no active participation from study subjects, no approval from an ethics committee was required according to Danish law. The use of register data was approved by the Danish Data Protection Agency.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement There are no unpublished data from the study.

    • Patient consent for publication Not required.

    Linked Articles