Clinical Experience with a Bradycardia Indicating Pacemaker

Rosenqvist, Mårten; Edhag, K. O.; Vallin, Hans

doi:10.1111/j.1540-8159.1983.tb05291.x

Cited by 15 publications

(3 citation statements)

References 20 publications

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“…All had had attacks on at least one day during the preceding 3 months. The mean number of days on which one or more blackouts had occurred was three (range [1][2][3][4][5][6][7][8]. Minor abnormalities of conduction or sinus node •Telectronics, London, England.…”

Section: Methodsmentioning

confidence: 99%

Unexplained Syncope—A Diagnostic Pacemaker?

Shaw

Kekwick

Veale

et al. 1983

Pacing Clinical Electrophis

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We describe our initial experience with a pacemaker which performs the dual function of registering episodes of cardiac arrest and pacing the heart when necessary. The apparatus has a prolonged escape interval (2.30-2.65 seconds) and is capable of counting up to 128 "events." Twenty-five patients complaining of infrequent episodes of loss of consciousness have been studied. Blackouts ceased and episodes of ventricular standstill were recorded in 14 cases; the unit helped to establish a non-cardiac etiology for the attacks in two cases. It is suggested that a bradycardia-recording facility incorporated into a programmable pacemaker would provide a much needed tool in the diagnosis and management of patients with infrequent episodes of loss of consciousness in whom a cardiac mechanism is suspected but unproven.

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Section: Methodsmentioning

confidence: 99%

Unexplained Syncope—A Diagnostic Pacemaker?

Shaw

Kekwick

Veale

et al. 1983

Pacing Clinical Electrophis

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“…This device allows the disclosure of the number of episodes with a spontaneous rate < 30 beats/min for 6 s by internal telemetry and has been shown to be a safe and sensitive tool for detecting atrioventricular block development. '5 17 Patients in the non-syncope group were not treated unless the disopyramide test was positive. All patients were seen at the outpatient clinic after six weeks and thereafter, on the average, every sixth month.…”

Section: Electrophysiological Studymentioning

confidence: 99%

Disopyramide stress test: a sensitive and specific tool for predicting impending high degree atrioventricular block in patients with bifascicular block.

Englund

Bergfeldt²,

Rosenqvist³

1995

Heart

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Objective-To study the value of intravenous disopyramide as part of an invasive electrophysiological study in predicting impending high degree atrioventricular block in patients with bifascicular block. Design-An invasive electrophysiological study was performed in the basal state and after the infusion of disopyramide (2 mg/kg body weight). The progression to high degree atrioventricular block was assessed by bradycardia-detecting pacemakers or repeated 12-lead electrocardiogram recordings, or both. Patients-73 patients with bifascicular block were included, of whom 25 had a history of unexplained syncope. The remaining 48 patients had no arrhythmia related symptoms and were included as controls. All patients had an ejection fraction of > 35%. Results-After a mean follow up of 23 months, seven patients in the syncope group and three in the non-syncope group had a documented high degree atrioventricular block or pacemaker-detected bradycardia of < 30 beatsimin for > 6 s. The sensitivity of the disopyramide test was 71% and the specificity 98%. The corresponding figures for an abnormal electrophysiological study in the basal state were 14% and 91%, respectively. Conclusions-The sensitivity of an invasive electrophysiological study in patients with bifascicular block and syncope can be markedly increased by the use of intravenous disopyramide. A positive test is a highly specific finding and warrants pacemaker implantation. (Br Heart J 1995;74:650-655) Keywords: disopyramide stress test, atrioventricular block, bifascicular block, electrophysiological study Bifascicular block, defined as left bundle branch block or right bundle branch block with left anterior or posterior fascicular block, has a prevalence of between 1% and 1-5% in an adult population.'-3 Up to 25% of patients with bifascicular block have a history of syncope3 and the management of these patients is a common clinical problem. The overall yearly incidence of progression to high degree atrioventricular block is only 1-4%3-5 and the strategy of pacemaker implantation in all symptomatic patients can thus be questioned. No non-invasive test has been found to be useful in predicting subsequent high degree atrioventricular block, and an invasive electrophysiological study is often of limited value.47 Findings with a high specificity, such as an HV interval of > 100 ms and a His-Purkinje block during atrial pacing, are rare and hence have a low sensitivity.5 8In order to increase the sensitivity of an electrophysiological study, a pharmacological stress test of the His-Purkinje system has been proposed, and ajmaline,9 10 procainamide,"-13 and disopyramide'4 '5 have been used for this purpose. The clinical value of these tests has, however, not been well defined, primarily because of the lack of appropriate controls and the lack of sensitive tools for detecting intermittent high degree atrioventricular block.The aim of this study was to evaluate prospectively the value of intravenous disopyramide as part of an invasive electrophysiological study...

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“…Although the implantable loop recorder (ILR) has emerged as a diagnostic tool [7], it offers no therapy and has a limited longevity. A bradycardia-detecting pacemaker (BDP) would be both a sensitive and safe tool to investigate patients with BFB and syncope [8,9,10]. Furthermore, a BDP makes it possible to study the temporal relationship between a syncopal attack (index episode) and the documentation of high-degree AV block in BFB patients.…”

Section: Introductionmentioning

confidence: 99%

Time Relation between a Syncopal Event and Documentation of Atrioventricular Block in Patients with Bifascicular Block: Clinical Implications

et al. 2006

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Background: Transient high-degree atrioventricular (AV) block is a common cause of syncope in patients with bifascicular block (BFB) but the intermittent nature of AV block makes ECG documentation a challenge. A sensitive and safe tool to investigate BFB patients with syncope would be a bradycardia-detecting pacemaker, which provides a possibility of studying the time relation between the index syncopal episode and the development of high-degree AV block. Methods: Twenty-seven patients with BFB and syncope were studied prospectively. All patients received a single-chamber ventricular-based pacemaker with bradycardia-detecting ability. A bradycardia episode was defined as a heart rate of <30 beats/min lasting ≧6 s. Results: During a median follow-up of 60 months, a bradycardia event was detected in 14 patients (52%), of whom 13 also had documented high-degree AV block on ECG. The median time between the syncopal episode and the first pacemaker-detected bradycardia event was 5 months and after an additional median time of 6 months, high-degree AV block was documented on the ECG. In 10 of 13 patients (77%) high-degree AV block was documented within 24 months of the syncopal episode corresponding to an annual incidence of 19% during the first 2 years of follow-up in the study population. Conclusion: In this group of BFB patients a syncopal episode was highly predictive of the development of high-degree AV block within 24 months, justifying pacemaker therapy without prior ECG verification.

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Clinical Experience with a Bradycardia Indicating Pacemaker

Cited by 15 publications

References 20 publications

Unexplained Syncope—A Diagnostic Pacemaker?

Unexplained Syncope—A Diagnostic Pacemaker?

Disopyramide stress test: a sensitive and specific tool for predicting impending high degree atrioventricular block in patients with bifascicular block.

Time Relation between a Syncopal Event and Documentation of Atrioventricular Block in Patients with Bifascicular Block: Clinical Implications

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