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Belhassen B, Lellouche N, Frank R. Contributions of France to the field of clinical cardiac electrophysiology and pacing. Heart Rhythm O2 2024; 5:490-514. [PMID: 39119028 PMCID: PMC11305881 DOI: 10.1016/j.hroo.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024] Open
Affiliation(s)
- Bernard Belhassen
- Heart Institute, Hadassah Medical Center, Jerusalem, Israel
- Tel-Aviv University, Tel-Aviv, Israel
| | - Nicolas Lellouche
- Unité de Rythmologie, Service de Cardiologie, Centre Hospitalier Henri-Mondor, Université Paris-Est, Créteil, France
| | - Robert Frank
- Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Université de la Sorbonne, Paris, France
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Doundoulakis I, Tsiachris D, Kordalis A, Soulaidopoulos S, Arsenos P, Xintarakou A, Koliastasis L, Vlachakis PK, Tsioufis K, Gatzoulis KA. Management of Patients With Unexplained Syncope and Bundle Branch Block: Predictive Factors of Recurrent Syncope. Cureus 2023; 15:e35827. [PMID: 37033500 PMCID: PMC10075189 DOI: 10.7759/cureus.35827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2023] [Indexed: 03/08/2023] Open
Abstract
Syncope in patients with bundle branch block (BBB) is often due to advanced atrioventricular (AV) block. The objective of the present "real-world" study was to evaluate the optimal management in patients with unexplained syncope and BBB and to identify factors that predict the recurrence of syncope. This is a single-center observational prospective registry of 131 consecutive patients undergoing invasive electrophysiology study (EPS) for recurrent unexplained presyncope or syncope attacks and BBB. When the EPS-derived diagnosis was reached, a decision to proceed with a permanent pacemaker was offered to the patient. An implantable loop recorder was inserted in the rest of the population. A total of 131 consecutive patients with unexplained syncope and BBB (67.2% male; age 63.7 ± 16.5 years) underwent EPS during the study period. The distribution of conduction disturbance patterns was as follows: isolated left bundle branch block (LBBB): 23.7%; LBBB with first AV block: 8.4%; isolated right bundle branch block (RBBB): 10.7%; RBBB with first AV block: 8.4%; isolated left anterior/posterior fascicular block: 13%; left anterior/posterior fascicular block with first AV block: 5.3%; isolated bifascicular block: 16.8%; and bifascicular block with first AV block: 13.7%. In the multivariate analysis, the only predictors of recurrent syncope were bifascicular block (hazard ratio (HR): 4.16, 95% confidence interval (CI): 1.29, 13.41, P: 0.017) and HV interval ≥ 60 msec (HR: 3.58, 95% CI: 1.12, 11.46, P: 0.032). An EPS-based strategy identifies a subset of patients who will benefit from permanent pacing. HV interval ≥ 60 msec and the presence of a bifascicular block were strongly related to syncope recurrence.
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Sheldon RS, Lei LY, Solbiati M, Chew DS, Raj SR, Costantino G, Morillo C, Sandhu RK. Electrophysiology studies for predicting atrioventricular block in patients with syncope: A systematic review and meta-analysis. Heart Rhythm 2021; 18:1310-1317. [PMID: 33887450 DOI: 10.1016/j.hrthm.2021.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/07/2021] [Accepted: 04/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Syncope may be caused by intermittent complete heart block in patients with bundle branch block. Electrophysiology studies (EPS) testing for infra-Hisian heart block are recommended by the European Society of Cardiology syncope guidelines on the basis of decades-old estimates of their negative predictive values (NPVs) for complete heart block. OBJECTIVE The aim of this study was to determine the NPV of EPS for complete heart block in patients with syncope and bundle branch block. METHODS We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL without language restriction from database inception to October 2019 for Medical Subject Headings terms and keywords related to "syncope," "heart block," and "programmed electrical stimulation." A random effects meta-analysis was conducted with a primary outcome of the proportion of patients with a negative EPS who later presented with complete heart block, diagnosed with surface electrocardiographic (ECG) recordings vs continuous implantable cardiac monitor (ICM). RESULTS Ten reports contained 12 cohorts with 639 patients who met the inclusion criteria. The mean age was 69 ± 7 years; 35% ± 10% were women; and 85% of patients had bifascicular block. Seven cohorts recorded clinical outcomes with external ECG recordings, and 5 cohorts featured ICMs. The mean prespecified His-to-ventricle interval criterion was ≥70 ms. In studies featuring surface ECG recordings, there were 7% (95% confidence interval 7%-17%) patients who developed complete heart block compared with 29% (95% confidence interval 24%-35%) in the studies featuring ICM (P = .0001). CONCLUSION The NPV of EPS in patients with syncope and bundle branch block is 0.71, sufficiently low to question its use.
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Affiliation(s)
- Robert S Sheldon
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.
| | - Lucy Y Lei
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Monica Solbiati
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Università degli Studi di Milano, Milan, Italy
| | - Derek S Chew
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Satish R Raj
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Giorgio Costantino
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Università degli Studi di Milano, Milan, Italy
| | - Carlos Morillo
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Roopinder K Sandhu
- University of Alberta, Edmonton, Alberta, Canada; Smidt Heart Institute, Cedars-Sinai Hospital, Los Angeles, California
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Mitro P, Šimurda M, Lazúrová Z, Jakubová M. Etiology of syncope in patients with preexisting atrioventricular conduction disorders. Pacing Clin Electrophysiol 2020; 43:1268-1272. [PMID: 32901951 DOI: 10.1111/pace.14064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/26/2020] [Accepted: 09/06/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The discussion about the feasibility of empiric pacemaker implantation in patients with preexisting atrioventricular (AV) conduction disorders continues. The aim of the study was to determine the etiology of syncope and the need for pacemaker insertion in patients with AV conduction impairment using implantable loop recorder (ILR). METHODS ILR was implanted after negative diagnostic workup in 37 patients with syncope (24 men, 13 women, age 72 ± 10 years) and preexisting impairment of AV conduction. First-degree AV block (AVB I) was present in 26 patients, and bundle branch block (BBB) in 17 patients. RESULTS ILR-based diagnosis was made in 28 patients (75%)-sinus arrest in 13 patients, complete AVB in 10 patients, and vasodepressor syncope in five patients. In patients with preexisting BBB, sinus arrest occurred during ILR monitoring significantly more frequently than in patients without BBB (53% vs 20%, P = .03). Complete AVB was significantly less common in patients with preexisting BBB than in patients without BBB (12% vs 40%, P = .04). On multivariate regression analysis, the only independent predictor of AVB occurrence during ILR monitoring was preexisting AVB I (P = .03). The only independent predictor of sinus arrest during ILR monitoring was preexisting BBB (P = .03). CONCLUSIONS In patients with preexisting AV conduction disorders, prevailing syncopal mechanism during ILR monitoring was asystole. However, sinus arrest occurred more often than complete AVB and was predicted by preexisting BBB. Preexisting AVB was a predictor of complete AVB during ILR monitoring.
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Affiliation(s)
- Peter Mitro
- Cardiology Clinic, Safarik University, VUSCH, Košice, Slovakia
| | - Miloš Šimurda
- Cardiology Clinic, Safarik University, VUSCH, Košice, Slovakia
| | - Zora Lazúrová
- Cardiology Clinic, Safarik University, VUSCH, Košice, Slovakia
| | - Marta Jakubová
- Cardiology Clinic, Safarik University, VUSCH, Košice, Slovakia
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Rankinen J, Haataja P, Lyytikäinen LP, Huhtala H, Lehtimäki T, Kähönen M, Eskola M, Pérez-Riera AR, Jula A, Rissanen H, Nikus K, Hernesniemi J. Long-term outcome of intraventricular conduction delays in the general population. Ann Noninvasive Electrocardiol 2020; 26:e12788. [PMID: 32804416 PMCID: PMC7816813 DOI: 10.1111/anec.12788] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/07/2020] [Accepted: 06/22/2020] [Indexed: 11/29/2022] Open
Abstract
Background Previous population studies have presented conflicting results regarding the prognostic impact of intraventricular conduction delays (IVCD). Methods We studied long‐term prognostic impact and the association with comorbidities of eight IVCDs in a random sample of 6,299 Finnish subjects (2,857 men and 3,442 women, mean age 52.8, SD 14.9 years) aged 30 or over who participated in the health examination including 12‐lead ECG. For left bundle branch block (LBBB) and non‐specific IVCD (NSIVCD), two different definitions were used. Results During 16.5 years’ follow‐up, 1,309 of the 6,299 subjects (20.8%) died and of these 655 (10.4%) were cardiovascular (CV) deaths. After controlling for known clinical risk factors, the hazard ratio for CV death, compared with individuals without IVCD, was 1.55 for the Minnesota definition of LBBB (95% confidence interval 1.04–2.31, p = .032) and 1.27 (95% confidence interval 0.80–2.02, p = .308) for the Strauss’ definition of LBBB. Subjects with NSIVCD were associated with twofold to threefold increase in CV mortality depending on the definition. While right bundle branch block, left anterior fascicular block and incomplete bundle branch blocks were associated with seemingly higher mortality, this was no longer the case after adjustment for age and sex. The presence of R‐R’ pattern was not associated with any adverse outcome. Conclusions In a population study with long‐term follow‐up, NSIVCD and Minnesota definition of LBBB were independently associated with CV mortality. Other IVCDs had no significant impact on prognosis. The prognostic impact of LBBB and NSIVCD was affected by the definition of the conduction disorder.
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Affiliation(s)
- Jani Rankinen
- Faculty of Medicine and Health Technology, Tampere University, and Finnish Cardiovascular Research Center, Tampere, Finland
| | - Petri Haataja
- Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
| | - Leo-Pekka Lyytikäinen
- Faculty of Medicine and Health Technology, Tampere University, and Finnish Cardiovascular Research Center, Tampere, Finland.,Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland.,Department of Clinical Chemistry, Tampere University Hospital, and Fimlab Laboratories, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Terho Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, and Finnish Cardiovascular Research Center, Tampere, Finland.,Department of Clinical Chemistry, Tampere University Hospital, and Fimlab Laboratories, Tampere, Finland
| | - Mika Kähönen
- Faculty of Medicine and Health Technology, Tampere University, and Finnish Cardiovascular Research Center, Tampere, Finland.,Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Markku Eskola
- Faculty of Medicine and Health Technology, Tampere University, and Finnish Cardiovascular Research Center, Tampere, Finland.,Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
| | | | - Antti Jula
- The Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Harri Rissanen
- The Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Kjell Nikus
- Faculty of Medicine and Health Technology, Tampere University, and Finnish Cardiovascular Research Center, Tampere, Finland.,Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
| | - Jussi Hernesniemi
- Faculty of Medicine and Health Technology, Tampere University, and Finnish Cardiovascular Research Center, Tampere, Finland.,Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
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Rivera-López R, Cabrera-Ramos M, Jordán-Martinez L, Jimenez-Jaimez J, Macias-Ruiz R, Aguilar-Alonso E, Rivera-Fernandez R, Sanchez-Cantalejo E, Tercedor L, Alvarez M. Syncope and bifascicular block in the absence of structural heart disease. Sci Rep 2020; 10:8139. [PMID: 32424127 PMCID: PMC7235078 DOI: 10.1038/s41598-020-65088-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 04/23/2020] [Indexed: 11/09/2022] Open
Abstract
The treatment of patients with bifascicular block (BFB) and syncope in the absence of structural heart disease (SHD) is not well defined. The objective of our study is to compare pacemaker empirical implantation with the use of electrophysiological studies (EPS). This is a prospective cohort study that included 77 patients with unexplained cardiogenic syncope and BFB without structural heart disease between 1997 and 2012. Two groups: 36 patients received empirical pacemakers (Group A) and 41 underwent EPS (Group B) to guide their treatment. The incidence of syncope recurrence and atrioventricular block was lower in group A. Mortality and complication rates were similar between both groups. Multivariate analysis demonstrated a higher number of events (combined endpoint) in group B. Our study shows that treatment according to EPS does not improve the results of a treatment strategy based on empirical pacemaker.
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Affiliation(s)
- Ricardo Rivera-López
- Cardiology Department, Hospital Universitario Virgen de las Nieves. Granada, Granada, Spain.,Granada Institute of Biohealth Research (Granada. Ibs), Granada, Spain
| | - Mercedes Cabrera-Ramos
- Cardiology Department, Hospital Universitario Virgen de las Nieves. Granada, Granada, Spain
| | - Laura Jordán-Martinez
- Cardiology Department, Hospital Universitario Virgen de las Nieves. Granada, Granada, Spain.,Granada Institute of Biohealth Research (Granada. Ibs), Granada, Spain
| | - Juan Jimenez-Jaimez
- Cardiology Department, Hospital Universitario Virgen de las Nieves. Granada, Granada, Spain.,Granada Institute of Biohealth Research (Granada. Ibs), Granada, Spain
| | - Rosa Macias-Ruiz
- Cardiology Department, Hospital Universitario Virgen de las Nieves. Granada, Granada, Spain.,Granada Institute of Biohealth Research (Granada. Ibs), Granada, Spain
| | | | | | - Emilio Sanchez-Cantalejo
- Granada Institute of Biohealth Research (Granada. Ibs), Granada, Spain.,Andalusian School of Public Health, Granada, Spain.,Epidemiology and Public Health Network Biomedical Research Consortium (CIBERESP), Madrid, Spain
| | - Luis Tercedor
- Cardiology Department, Hospital Universitario Virgen de las Nieves. Granada, Granada, Spain.,Granada Institute of Biohealth Research (Granada. Ibs), Granada, Spain
| | - Miguel Alvarez
- Cardiology Department, Hospital Universitario Virgen de las Nieves. Granada, Granada, Spain.,Granada Institute of Biohealth Research (Granada. Ibs), Granada, Spain
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Syncope, conduction disturbance, and negative electrophysiological test: Predictive factors and risk score to predict pacemaker implantation during follow-up. Heart Rhythm 2019; 16:905-912. [PMID: 30576876 DOI: 10.1016/j.hrthm.2018.12.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Indexed: 12/27/2022]
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Roca-Luque I, Oristrell G, Francisco-Pasqual J, Rodríguez-García J, Santos-Ortega A, Martin-Sanchez G, Rivas-Gandara N, Perez-Rodon J, Ferreira-Gonzalez I, García-Dorado D, Moya-Mitjans A. Predictors of positive electrophysiological study in patients with syncope and bundle branch block: PR interval and type of conduction disturbance. Clin Cardiol 2018; 41:1537-1542. [PMID: 30251426 DOI: 10.1002/clc.23079] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/22/2018] [Accepted: 09/20/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Electrophysiological study (EPS) is indicated in patients with syncope and bundle branch block (BBB). Data about predictors of positive EPS in these patients is scarce. OBJECTIVE To assess clinical and electrocardiographic (ECG) predictors of positive EPS in patients with syncope and BBB. METHODS Observational single-center study that included all consecutive patients with syncope and BBB that underwent EPS from January 2011 to June 2017. Results of EPS were considered positive according to current ESC syncope guidelines. RESULTS During study period, 271 patients were included (64.9% male, age: 73.9 ± 12.2 years, number of syncopal episodes: 2.4 ± 2.5, LVEF: 56.1 ± 9.9%). Type of BBB: RBBB + LAFB/LPFB in 39.8%, isolated LBBB in 38.7% and isolated RBBB in 18.5% of the patients. Duration of QRS and PR interval were 141.9 ± 16.7 and 182.8 ± 52.2 milliseconds. EPS was positive in 41.7% of the patients. In multivariate analysis, conduction disturbance pattern and long PR interval (OR 8.6; 2.9-25; P < 0.0001) were predictors of positive EPS. Conduction disturbance patterns related with positive EPS were: BBB different than isolated RBBB (OR 15.2; 2.2-23.4; P = 0.005), LBBB or RBBB+long PR + left fascicular block (OR 4.5; 1.06-20.01; P < 0.042), and RBBB+left fascicular block compared with LBBB (OR 4.8; 1.2-16.7; P = 0.025). Clinical factors and syncope characteristics were not related with EPS result. CONCLUSIONS Diagnostic yield of EPS in patients with syncope and BBB is moderate (41%). Type of conduction disturbance pattern and PR interval are associated with the electrophysiological (EP) test result. Patients with LBBB or bifascicular block have the highest rate of positive EP test. Long PR interval increases the proportion of positive EPS in all conduction disturbance patterns.
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Affiliation(s)
- Ivo Roca-Luque
- Arrhythmia Unit. Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Gerard Oristrell
- Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | - Alba Santos-Ortega
- Arrhythmia Unit. Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Gabriel Martin-Sanchez
- Arrhythmia Unit. Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Nuria Rivas-Gandara
- Arrhythmia Unit. Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jordi Perez-Rodon
- Arrhythmia Unit. Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ignacio Ferreira-Gonzalez
- Cardiovascular epidemiology Unit. Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Angel Moya-Mitjans
- Arrhythmia Unit. Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Pentimalli F, Bacino L, Ghione M, Giambattista S, Gazzarata M, Bellotti P. Ajmaline Challenge To Unmask Infrahisian Disease In Patients With Recurrent And Unexplained Syncope, Preserved Ejection Fraction, With Or Without Conduction Abnormalities On Surface ECG. J Atr Fibrillation 2016; 9:1421. [PMID: 27909532 DOI: 10.4022/jafib.1421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 08/22/2016] [Accepted: 08/26/2016] [Indexed: 11/10/2022]
Abstract
Background: Pharmacological challenge with class I antiarrhythmic drug is a recommended diagnostic test in patients with unexplained syncope only in the presence of bundle branch block, when non-invasive tests have failed to make the diagnosis. Its role in patients with minor or no conduction disturbances on 12-leads ECG has not been evaluated yet. It is also not clear which are the values of His-Ventricular interval to be considered diagnostic. We sought to evaluate the role of ajmaline challenge in unmasking the presence of an infrahisian disease in patients with recurrent and unexplained syncope, regardless of the existence of conduction disturbances on surface ECG. Materials And Methods: Patients with history of recurrent syncope, preserved EF and a negative first level workup were enrolled. Conduction disturbances on ECG were not considered as an exclusion criteria. During EPS, basal HV conduction was determined. In the presence of a HV >70 msec the study was interrupted and the patient was implanted with a pacemaker. If the HV was ≤ 70 msec, ajmaline was infused and HV was reassessed. The maximum value of HV was considered. A prolongation ≥ 100 msec was considered as diagnostic and indicative of conduction disease, and the patient underwent pacemaker implantation. Patients with an HV <100 msec were implanted with an ILR. Results: Sixteen consecutive patients were studied (age 76±5.2 years). Nine patients had conduction disturbances at baseline ECG (group ECG+). Among them, 5 had a basal diagnostic HV interval and 4 had a non-diagnostic HV interval. In the latter group, abnormal response to ajmaline was observed in 3 patients. In this group only one patient was implanted with an ILR, 8 patients were implanted with a pacemaker. Among the seven patients without conduction disturbances (group ECG-), no one had a diagnostic basal HV interval. After drug administration, 4 patients had a non-diagnostic response and were implanted with an ILR, while 3 patient had a pathological response and were implanted with a pacemaker. No difference was found in the values of maximum HV interval prolongation after ajmaline between the two groups (P = 0.89). During a mean follow up of 13±3 months, no patient has developed a syncopal episode. One patient in group ECG- and negative drug test was implanted after 3 months with a permanent pacemaker because of a two to one asymptomatic AV block at ILR interrogation. Conclusions: Ajmaline challenge is a useful tool to unmask the presence of a infrahisian disease in patients with preserved EF, unexplained syncope and negative workup, even in the absence of conduction disturbances on 12-leads ECG. It is a simple and safe test that may disclose the detection of the disease. In these patients, an earlier pacemaker implantation of a pacemaker, may avoid the consequences of a syncopal recurrence. Values of HV interval > 70 msec in basal conditions and ≥ 100 msec after ajmaline administration seem appropriate to unmask infrahisian disease. Larger population is required to validate this hypothesis.
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Affiliation(s)
| | - Luca Bacino
- EP Lab, S.C. Cardiologia/Unità Coronarica Ospedale S Paolo - ASL 2 Savonese
| | - Matteo Ghione
- EP Lab, S.C. Cardiologia/Unità Coronarica Ospedale S Paolo - ASL 2 Savonese
| | - Siri Giambattista
- EP Lab, S.C. Cardiologia/Unità Coronarica Ospedale S Paolo - ASL 2 Savonese
| | - Massimo Gazzarata
- EP Lab, S.C. Cardiologia/Unità Coronarica Ospedale S Paolo - ASL 2 Savonese
| | - Paolo Bellotti
- EP Lab, S.C. Cardiologia/Unità Coronarica Ospedale S Paolo - ASL 2 Savonese
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Mair L, Warriner D, Payne G. Assessment of an incidental finding of left bundle-branch block. Br J Hosp Med (Lond) 2015; 76:196-9. [PMID: 25853348 DOI: 10.12968/hmed.2015.76.4.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Incidental left bundle-branch block occurs in up to 1.5% of healthy adults without symptoms or signs of cardiovascular disease. It may be found during investigation for non-cardiac disease, during preoperative assessment, private health screening or inpatient monitoring. This article outlines how to assess these patients.
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Affiliation(s)
- Luke Mair
- Senior House Officer in the Department of Critical Care, Doncaster Royal Infirmary, Doncaster, South Yorkshire DN2 5LT
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