{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T19:35:39Z","timestamp":1776972939585,"version":"3.51.4"},"reference-count":28,"publisher":"IMR Press","issue":"12","license":[{"start":{"date-parts":[[2024,12,3]],"date-time":"2024-12-03T00:00:00Z","timestamp":1733184000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Cardiovasc. Med."],"abstract":"<jats:p>Background: It is not uncommon that atrial fibrillation (AF) coexists with left bundle branch block (LBBB). Whether LBBB is an independent predictor of poor prognosis in AF patients remains undetermined. This study aims to investigate the impact of LBBB on the AF-related outcomes in non-valvular AF patients. Methods: The clinical data of AF patients were collected from the Medical Information Mart for Intensive Care-III (MIMIC-III) database. The frequencies of acute arterial embolism events (AEE) and in-hospital cardiac death were compared between the non-LBBB and LBBB groups. And, their 1-year mortality was assessed through a survival analysis model. Additionally, the two groups were matched in a 1:2 ratio by a propensity score matching (PSM) method according to the CHA2DS2VASc score and AF type. Results: 5051 patients diagnosed with non-valvular AF without apparent structural heart disease were enrolled in this study, among them, there were 65 with LBBB which had more AEE (13.8% vs 6.8%, p = 0.04). After PSM, with balanced CHA2DS2VASc score and AF type, LBBB was still related with AEE (13.8% vs 3.8%, p = 0.02) significantly, and it was also independent of heart failure (HF) (odds ratios (OR) 6.38, 95% confidence intervals (CI) [1.10, 36.93], p = 0.04). LBBB was also correlated with in-hospital cardiac death (OR 5.33, 95% CI [1.01, 28.28], p = 0.04). And, the LBBB patients had a lower 1-year survival rate in the subgroup of HF (67.6% vs 83.0%, p = 0.06). Conclusions: The LBBB was an independent risk factor of AEE and related to in-hospital cardiac death and 1-year all-cause mortality in this non-valvular AF cohort from MIMIC-III.<\/jats:p>","DOI":"10.31083\/j.rcm2512429","type":"journal-article","created":{"date-parts":[[2024,12,30]],"date-time":"2024-12-30T10:43:39Z","timestamp":1735555419000},"source":"Crossref","is-referenced-by-count":1,"title":["Adding Insult to Injury: When Atrial Fibrillation Encounters Left Bundle Branch Block"],"prefix":"10.31083","volume":"25","author":[{"given":"Dong-sheng","family":"Zhao","sequence":"first","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, 210029 Nanjing, Jiangsu, China"},{"name":"Department of Cardiology, The Second Affiliated Hospital of Nantong University, 226019 Nantong, Jiangsu, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nishant","family":"Yadav","sequence":"first","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, 210029 Nanjing, Jiangsu, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"Dong","sequence":"first","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, 210029 Nanjing, Jiangsu, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qiu-shi","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, 210029 Nanjing, Jiangsu, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Di","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, 210029 Nanjing, Jiangsu, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Feng-xiang","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, 210029 Nanjing, Jiangsu, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"16242","published-online":{"date-parts":[[2024,12,3]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Cheng S, He J, Han Y, Han S, Li P, Liao H, et al. Global burden of atrial fibrillation\/atrial flutter and its attributable risk factors from 1990 to 2021. Europace. 2024; 26: euae195.","DOI":"10.1093\/europace\/euae195"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Van Gelder IC, Rienstra M, Bunting KV, Casado-Arroyo R, Caso V, Crijns HJGM, et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). European Heart Journal. 2024; 45: 3314\u20133414.","DOI":"10.1093\/eurheartj\/ehae176"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Jiang H, Yan W, Han P, Zhang J, Miao H, Liang G, et al. The predictive value of CHA2DS2-VASc score on the prognosis of patients with atrial fibrillation based on a prospective cohort study. Journal of Thoracic Disease. 2024; 16: 3932\u20133943.","DOI":"10.21037\/jtd-24-737"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Melgaard L, Gorst-Rasmussen A, Lane DA, Rasmussen LH, Larsen TB, Lip GYH. Assessment of the CHA2DS2-VASc Score in Predicting Ischemic Stroke, Thromboembolism, and Death in Patients With Heart Failure With and Without Atrial Fibrillation. JAMA. 2015; 314: 1030\u20131038.","DOI":"10.1001\/jama.2015.10725"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Ga\u017eov\u00e1 A, Leddy JJ, Rexov\u00e1 M, Hliv\u00e1k P, Hatala R, Kyselovi\u010d J. Predictive value of CHA2DS2-VASc scores regarding the risk of stroke and all-cause mortality in patients with atrial fibrillation (CONSORT compliant). Medicine. 2019; 98: e16560.","DOI":"10.1097\/MD.0000000000016560"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"Wan D, Andrade J, Laksman Z. Thromboembolic risk stratification in atrial fibrillation-beyond clinical risk scores. Reviews in Cardiovascular Medicine. 2021; 22: 353\u2013363.","DOI":"10.31083\/j.rcm2202042"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Khurshid S, Frankel DS. Pacing-Induced Cardiomyopathy. Cardiac Electrophysiology Clinics. 2021; 13: 741\u2013753.","DOI":"10.1016\/j.ccep.2021.06.009"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"Khan MZ, Patel K, Zarak MS, Gupta A, Hussian I, Patel K, et al. Association between atrial fibrillation and bundle branch block. Journal of Arrhythmia. 2021; 37: 949\u2013955.","DOI":"10.1002\/joa3.12556"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"Pujol-L\u00f3pez M, Tolosana JM, Upadhyay GA, Mont L, Tung R. Left Bundle Branch Block: Characterization, Definitions, and Recent Insights into Conduction System Physiology. Cardiology Clinics. 2023; 41: 379\u2013391.","DOI":"10.1016\/j.ccl.2023.03.003"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"Tang RB, Lv WH, Long DY, Dong JZ, Du X, Sang CH, et al. Catheter ablation of atrial fibrillation in patients with left bundle branch block. Pacing and Clinical Electrophysiology. 2024; 47: 518\u2013524.","DOI":"10.1111\/pace.14954"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Rodr\u00edguez-Ma\u00f1ero M, Abu-Assi E, L\u00f3pez MJV, de Blas Abad P, Fern\u00e1ndez GG, Alcalde CC, et al. Left bundle branch block in atrial fibrillation patients without heart failure. International Journal of Cardiology. 2013; 168: 5460\u20135462.","DOI":"10.1016\/j.ijcard.2013.07.250"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"Johnson AEW, Pollard TJ, Shen L, Lehman LWH, Feng M, Ghassemi M, et al. MIMIC-III, a freely accessible critical care database. Scientific Data. 2016; 3: 160035.","DOI":"10.1038\/sdata.2016.35"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"Austin PC. Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharmaceutical Statistics. 2011; 10: 150\u2013161.","DOI":"10.1002\/pst.433"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"Mathew D, Agarwal S, Sherif A. Impact of left bundle branch block on heart failure with preserved ejection fraction. Pacing and Clinical Electrophysiology. 2023; 46: 422\u2013424.","DOI":"10.1111\/pace.14690"},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"Darmon A, Ducrocq G, Elbez Y, Popovic B, Sorbets E, Ferrari R, et al. Prevalence, Incidence and Prognostic Implications of Left Bundle Branch Block in Patients with Chronic Coronary Syndromes (From the CLARIFY Registry). The American Journal of Cardiology. 2021; 150: 40\u201346.","DOI":"10.1016\/j.amjcard.2021.03.047"},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"Bazoukis G, Tsimos K, Korantzopoulos P. Episodic Left Bundle Branch Block-A Comprehensive Review of the Literature. Annals of Noninvasive Electrocardiology. 2016; 21: 117\u2013125.","DOI":"10.1111\/anec.12361"},{"key":"ref17","doi-asserted-by":"publisher","unstructured":"Li W, Sun J, Yu Y, Guo K, Wang QS, Zhang PP, et al. What is the role of left bundle branch block in atrial fibrillation-induced cardiomyopathy? International Journal of Cardiology. 2015; 184: 382\u2013384.","DOI":"10.1016\/j.ijcard.2015.02.060"},{"key":"ref18","doi-asserted-by":"publisher","unstructured":"Andersen \u00d8S, Krogh MR, Boe E, Storsten P, Aalen JM, Larsen CK, et al. Left bundle branch block increases left ventricular diastolic pressure during tachycardia due to incomplete relaxation. Journal of Applied Physiology. 2020; 128: 729\u2013738.","DOI":"10.1152\/japplphysiol.01002.2018"},{"key":"ref19","doi-asserted-by":"publisher","unstructured":"Ypenburg C, Lancellotti P, Tops LF, Boersma E, Bleeker GB, Holman ER, et al. Mechanism of improvement in mitral regurgitation after cardiac resynchronization therapy. European Heart Journal. 2008; 29: 757\u2013765.","DOI":"10.1093\/eurheartj\/ehn063"},{"key":"ref20","doi-asserted-by":"publisher","unstructured":"Supariwala AA, Po JRF, Mohareb S, Aslam F, Kaddaha F, Mian ZI, et al. Prevalence and long-term prognosis of patients with complete bundle branch block (right or left bundle branch) with normal left ventricular ejection fraction referred for stress echocardiography. Echocardiography. 2015; 32: 483\u2013489.","DOI":"10.1111\/echo.12680"},{"key":"ref21","doi-asserted-by":"publisher","unstructured":"Hawkins NM, Wang D, McMurray JJV, Pfeffer MA, Swedberg K, Granger CB, et al. Prevalence and prognostic impact of bundle branch block in patients with heart failure: evidence from the CHARM programme. European Journal of Heart Failure. 2007; 9: 510\u2013517.","DOI":"10.1016\/j.ejheart.2006.11.006"},{"key":"ref22","doi-asserted-by":"publisher","unstructured":"Reil JC, Robertson M, Ford I, Borer J, Komajda M, Swedberg K, et al. Impact of left bundle branch block on heart rate and its relationship to treatment with ivabradine in chronic heart failure. European Journal of Heart Failure. 2013; 15: 1044\u20131052.","DOI":"10.1093\/eurjhf\/hft072"},{"key":"ref23","doi-asserted-by":"publisher","unstructured":"Ku\u010derov\u00e1 A, Do\u0161k\u00e1\u0159 P, Dujka L, Leke\u0161ov\u00e1 V, Volf P, Ko\u0161\u010dov\u00e1 K, et al. Heart rate reduction after ivabradine might be associated with reverse electrical remodeling in patients with cardiomyopathy and left bundle branch block. The Journal of International Medical Research. 2018; 46: 4825\u20134828.","DOI":"10.1177\/0300060518799566"},{"key":"ref24","doi-asserted-by":"publisher","unstructured":"Hasebe H. A Patient with Left Bundle Branch Block and Persistent Atrial Fibrillation Treated with Cardiac Catheter Ablation and Pharmacologic Cardiac Resynchronization Therapy without the Use of an Implantable Cardiac Device. The American Journal of Case Reports. 2018; 19: 123\u2013127.","DOI":"10.12659\/ajcr.907268"},{"key":"ref25","doi-asserted-by":"publisher","unstructured":"Chen M, Dong Z, Zhang Y, Liu J, Zhang J. A conversion CRT strategy combined with AVJA may be a perspective alternative for heart failure patients with persistent atrial fibrillation. Heart Failure Reviews. 2023; 28: 367\u2013377.","DOI":"10.1007\/s10741-023-10294-6"},{"key":"ref26","doi-asserted-by":"publisher","unstructured":"Ferreira AM, Adrag\u00e3o P, Cavaco DM, Candeias R, Morgado FB, Santos KR, et al. Benefit of cardiac resynchronization therapy in atrial fibrillation patients vs. patients in sinus rhythm: the role of atrioventricular junction ablation. Europace. 2008; 10: 809\u2013815.","DOI":"10.1093\/europace\/eun135"},{"key":"ref27","doi-asserted-by":"publisher","unstructured":"Wu S, Cai M, Zheng R, Wang S, Jiang L, Xu L, et al. Impact of QRS morphology on response to conduction system pacing after atrioventricular junction ablation. ESC Heart Failure. 2021; 8: 1195\u20131203.","DOI":"10.1002\/ehf2.13181"},{"key":"ref28","doi-asserted-by":"publisher","unstructured":"Baldasseroni S, De Biase L, Fresco C, Marchionni N, Marini M, Masotti G, et al. Cumulative effect of complete left bundle-branch block and chronic atrial fibrillation on 1-year mortality and hospitalization in patients with congestive heart failure. A report from the Italian network on congestive heart failure (in-CHF database). European Heart Journal. 2002; 23: 1692\u20131698.","DOI":"10.1053\/euhj.2001.3157"}],"container-title":["Reviews in Cardiovascular Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.imrpress.com\/journal\/RCM\/25\/12\/10.31083\/j.rcm2512429","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,30]],"date-time":"2024-12-30T11:03:38Z","timestamp":1735556618000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.imrpress.com\/journal\/RCM\/25\/12\/10.31083\/j.rcm2512429"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,3]]},"references-count":28,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2024]]}},"alternative-id":["S1530-6550(24)01639-9"],"URL":"https:\/\/doi.org\/10.31083\/j.rcm2512429","relation":{},"ISSN":["1530-6550","2153-8174"],"issn-type":[{"value":"1530-6550","type":"print"},{"value":"2153-8174","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,3]]},"article-number":"429"}}