Increased QRS and LBBB in CHF

Q: QRS prolongation is associated with increased mortality in heart failure patients?

A) True

B) False

Answer: A

A QRS duration ≥120 ms is highly associated with increased all-cause mortality in congestive heart failure (CHF) patients. QRS prolongation leads to conduction defect and ventricular dyssynchrony. Similarly, one-fourth of these patients have Left bundle branch block (LBBB) and is also associated with increased all-cause mortality and sudden cardiac death. LBBB is also considered a marker even if not a direct cause of increased mortality risk. 

Clinical implication: Cardiac resynchronization with biventricular pacing should highly be considered.

#cardiology

References:

1. Wang NC, Maggioni AP, Konstam MA, et al. Clinical implications of QRS duration in patients hospitalized with worsening heart failure and reduced left ventricular ejection fraction. JAMA 2008; 299:2656.

2. Baldasseroni S, Opasich C, Gorini M, et al. Left bundle-branch block is associated with increased 1-year sudden and total mortality rate in 5517 outpatients with congestive heart failure: a report from the Italian network on congestive heart failure. Am Heart J 2002; 143:398.

3. Tabrizi F, Englund A, Rosenqvist M, et al. Influence of left bundle branch block on long-term mortality in a population with heart failure. Eur Heart J 2007; 28:2449.