Significance of chronic bifascicular block without apparent organic heart disease

Eighty-six of 452 patients (19%) with chronic bifascicular block were found to have no clinically apparent organic heart disease (OHD) and were defined as having primary conduction disease (PCD). Comparison of patients with PCD and OHD revealed a significantly lower incidence of the following clinical variables in the PCD patients (p<0.001): exertional angina, dyspnea, congestive heart failure, cardiomegaly, functonal class I (all by study design), left bundle branch block and premature ventricular contractions. Both mean AH and HV intervals were significantly shorter in patients with PCD (p<0.01). The incidence of HV prolongations was 21% in PCD and 41% in OHD patients (p<0.001). All patients were prospectively followed for 21-2998 days with a mean ± SEM of 1209 ± 66 days for PCD and 1172 ± 36 days for OHD. Atrioventricular (AV) block developed in three patients from the PCD group and 26 from the OHD group (NS), with spontaneous block occurring in one (1%) PCD patient and 19 (5%) OHD patients (p<0.05). Annual mortality due to sudden death as well as total cardiovascular mortality (including sudden death) for the 5-year follow-up was significantly lower in patients with PCD. Patients with PCD have a significantly lower incidence of electrophysiologic abnormalities and subsequent spontaneous AV block as well as cardiovascular and sudden death mortality. The diagnosis of PCD based on clinical criteria probably underestimates the presence of underlying OHD, as suggested by a small but definite risk of cardiovascular mortality.