![]() ![]() The participants in the survey signed an informed consent both before the health interview and at the beginning of the health examination.Ģ.2. ![]() The study protocol of the Health 2000 survey was approved by the Epidemiology Ethics Committee of the Helsinki and Uusimaa Hospital District. The National Care Register for Health Care and the national register on rights to reimbursements for medication costs were linked to the Health 2000 Survey data. After a home interview, a comprehensive health examination, including questionnaires, measurements (e.g., blood pressure and resting ECG), and physician's physical examination, was performed. The Health 2000 sample comprised random sample of 8 028 individuals (3 637 men and 4 391 women) aged 30 or older, of whom 79% (6 354 individuals 2 876 men and 3 478 women) participated in the health examination. The implementation of the survey was described in detail elsewhere (Heistaro, 2000). For the population aged ≥ 80 years, the sampling probability was twice as high as among those <80 years. The survey was carried out in 2000–2001, and a representative stratified random cluster sample of the Finnish population was examined. The Health 2000 is a major Finnish health examination survey. The purpose of this study was to explore the prevalence, relation to CV comorbidities and prognostic significance of IVCDs in a predominantly Caucasian general population during a total follow‐up time of 16.5 years. These recommendations are based on observational evidence, and due to the limited data, there is no consensus on the need of follow‐ups after the initial screening. While the current guidelines suggest the use of transthoracic echocardiography to rule out structural heart disease in isolated LBBB, the recommendation is less stringent in patients with conduction disorders other than LBBB (Kusumoto et al., 2018). Only two prior population studies have assessed the clinical significance of incomplete LBBB (iLBBB) and found no relation to CV mortality (Haataja et al., 2015) (Tervahauta, Pekkanen, Punsar, & Nissinen, 1996). Somewhat surprisingly, one previous study found that incomplete RBBB (iRBBB) was associated with increased all‐cause and CV mortality (Haataja et al., 2015). Previous scientific literature does not provide much information about the prevalence or prognostic significance of incomplete bundle branch blocks in individuals apparently free of CV disease. Isolated left posterior fascicular block (LPFB) is a rare conduction disorder with no clear consensus on prognostic significance without CV disease (Pérez‐Riera et al., 2018). Left anterior fascicular block (LAFB) is usually regarded as a conduction disorder without clinical significance if encountered in asymptomatic individuals (Elizari, Acunzo, and Ferreiro, 2007). The effect of the ECG definitions of LBBB and NSIVCD on outcome has not been reported in prior population studies. On the other hand, non‐specific IVCD (NSIVCD) is considered as an ECG marker of adverse outcome due to its potential association with structural heart disease (Eschalier et al., 2015 Haataja et al., 2015). The results of studies evaluating the prognostic impact of LBBB on all‐cause mortality in subjects without known CV disease are also somewhat conflicting (Haataja et al., 2015 Imanishi et al., 2006 Schneider, Thomas, Kreger, McNamara, & Kannel, 1979), and even the standard electrocardiographic (ECG) criteria for LBBB have been challenged (Strauss, Selvester, & Wagner, 2011). Some authors showed that RBBB was associated with increased all‐cause mortality, while other investigators found no effect on outcome (Bussink et al., 2013 Haataja et al., 2015). In subjects with IVCDs without other evidence of cardiac disease (isolated bundle branch block), published reports show conflicting results. Both right (RBBB) and left bundle branch blocks (LBBB) are associated with adverse outcome in subjects with overt cardiovascular disease (CV Wang et al., 2008 Zhang et al., 2012). The clinical significance of various intraventricular conduction delays (IVCD) depends on the type of the conduction disorder and on the studied patient population. ![]()
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