Incremento en la duraciÓn del QRS: signo de mal pronÓstico en pacientes con insuficiencia cardíaca avanzada

Left intraventricular disturbance and in fact LBBB are both shown as a prognosis markers in the heart failure setting. Aim: establish the relationship in a cohort of patients with advanced heart failure (NYHA class III-IV) between mortality and its intraventricular conduction disturbances. Methods: in a group of 104 patients with dilated myocardiopathy, were selected a subgroup of 15 of them which presented with intraventricular disturbance (qRS >110 msec.) with a 24 months of follow up of average (12-36 mo.). The mean age of the subgroup was 70 years old (56-77 range), nine of them were male. All of them were in NYHA class III-IV and left ventricular ejection fraction of 29%. Ischemic was the etiology in 66.6% of them. Results: the average qRS duration was 139.6 msec. During the follow-up, 13 patients showed a progression in its qRs duration (average of 172.5 msec., 23.6% of increasing) (Group I) and two patients didn't suffer any modification (110/115 msec. respectively) (Group II). 6/13 pts. from Group I died (46.1%) all of them with permanent pacemaker and 7 (53.8%) remain still alive. From this last subgroup of alive patients, five were implanted on cardiac resynchronization (38.46%), one needed an intracardiac defibrillator (7.6%) and only one of the patients remain only on pharmacologic measures. Regarding the two patients from Group II, they remain alive with medical treatment. Conclusions: progression of intraventricular disturbances in patients with advanced heart failure was a marker of bad prognosis in the long-term evolution. All patients in which a progression in these disturbances was not observed or were implanted on cardiac resynchronization, develop less mortality in a two years follow-up.