Association between Progressive Intraventricular Conduction Disturbance and Cardiovascular Events

BACKGROUND Prolonged QRS duration on electrocardiogram (ECG) has been known as a poor prognostic marker. However, little is known about association between progressive intraventricular conduction disturbance and cardiovascular prognosis. METHODS From among a database containing 359,737 12-lead ECG recordings, patients whose QRS duration progressively increased from <120 msec to ≥120 msec were selected using software. The prognosis of patients was searched by medical record. The primary endpoint was defined as heart failure hospitalization. The secondary endpoint was heart failure hospitalization, device implantation, or cardiovascular death. RESULTS A total of 143 patients (100 males; age, 58.9±11.1 years) were enrolled in this study. QRS duration increased by 46.4±13.8 msec, manifesting right bundle branch block (RBBB) in 99 (69.2%) patients and non-RBBB (i.e., left bundle branch block, RBBB with left anterior hemiblock, or nonspecific intraventricular conduction disturbance) in 44 (30.8%). During the follow-up (mean, 16.6±5.3 years), 44 (30.3%), 15 (10.3%), and 6 (4.1%) patients resulted in heart failure hospitalization, device implantation, and cardiovascular death, respectively. Multivariate Cox proportional hazards models revealed that 1) the temporal increase in QRS duration was associated with the primary endpoint (hazard ratio [HR] 1.98; 95% confidence interval [CI] 1.05-3.80; p = 0.04) and the secondary endpoint (HR 2.79; 95% CI 1.55-5.00; p = 0.0001) and 2) the development of non-RBBB was associated with the primary endpoint (HR 3.02; 95% CI 1.59-5.73; p = 0.0001) and the secondary endpoint (HR 2.82; 95% CI 1.57-5.09; p = 0.001). CONCLUSION The temporal increase in QRS duration and the development of non-RBBB patterns were independently associated with adverse cardiovascular prognosis.