Bundle-branch block in middle-aged men: risk of complications and death over 28 years

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Abstract
Aims To investigate the long-term fate of men with bundle-branch block (BBB) from a general population sample. Methods and results Data were derived from 7392 men without a history of myocardial infarction or stroke, born between 1915 and 1925 and investigated between 1970 and 1973. All participants were followed from the date of their baseline examination until 1998. We identified 70 men with right-BBB and 46 men with left-BBB at baseline. In men with right-BBB, there was no increased risk of myocardial infarction, coronary death, heart failure, or all-cause mortality during follow-up. The multiple-adjusted hazard ratio for progression to high-degree atrioventricular block was 3.64 (99% confidence interval 0.79–16.72). In men with left-BBB, the hazard ratio for high-degree atrioventricular block was 12.89 (4.13–40.24). However, hazard ratio for all-cause mortality was 1.85 (1.15–2.97) when compared with men without BBB, mostly due to outside hospital coronary deaths, whose hazard ratio was 4.22 (1.90–9.34). Conclusion The presence of BBB was strongly associated with future high-degree atrioventricular block that was more pronounced for left-BBB. Men with left-BBB have a substantially increased risk of coronary death, mainly due to sudden death outside the hospital setting.