Electrophysiologic testing in bundle branch block and unexplained syncope

Morady, Fred; Higgins, James; Peters, Robert W.; Schwartz, A. B.; Shen, Edward; Bhandari, Anil K.; Scheinman, Melvin M.; Sauvé, Mary Jane

doi:10.1016/0002-9149(84)90254-6

Cited by 129 publications

(29 citation statements)

References 20 publications

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“…Although syncope may be recurrent, it is not associated with an increased incidence of sudden death. 73,[102][103][104][105][106][107][108][109][110][111][112] Even though pacing relieves the neurological symptoms, it does not reduce the occurrence of sudden death. 108 An electrophysiological study may be helpful to evaluate and direct the treatment of inducible ventricular arrhythmias 113,114 that are common in patients with bifascicular block.…”

Section: Chronic Bifascicular Blockmentioning

confidence: 99%

“…64,114,115 Finally, if the cause of syncope in the presence of bifascicular block cannot be determined with certainty, or if treatments used (such as drugs) may exacerbate AV block, prophylactic permanent pacing is indicated, especially if syncope may have been due to transient thirddegree AV block. [102][103][104][105][106][107][108][109][110][111][112]116 Of the many laboratory variables, the PR and HV intervals have been identified as possible predictors of third-degree AV block and sudden death. Although PR-interval prolongation is common in patients with bifascicular block, the delay is often at the level of the AV node.…”

Section: Chronic Bifascicular Blockmentioning

confidence: 99%

“…There is no correlation between the PR and HV intervals or between the length of the PR interval, progression to third-degree AV block, and sudden death. 107,109,116 Although most patients with chronic or intermittent third-degree AV block demonstrate prolongation of the HV interval during anterograde conduction, some investigators 110,111 have suggested that asymptomatic patients with bifascicular block and a prolonged HV interval should be considered for permanent pacing, especially if the HV interval is greater than or equal to 100 milliseconds. 109 Although the prevalence of HVinterval prolongation is high, the incidence of progression to third-degree AV block is low.…”

Section: Chronic Bifascicular Blockmentioning

confidence: 99%

See 2 more Smart Citations

ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities

Epstein¹,

DiMarco²,

Ellenbogen³

et al. 2008

Circulation

1,243

488

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Section: Chronic Bifascicular Blockmentioning

confidence: 99%

Section: Chronic Bifascicular Blockmentioning

confidence: 99%

Section: Chronic Bifascicular Blockmentioning

confidence: 99%

See 1 more Smart Citation

ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities

Epstein¹,

DiMarco²,

Ellenbogen³

et al. 2008

Circulation

1,243

488

View full text Add to dashboard Cite

“…False-positive results of EP testing can be present in up to 24% of the patients. In syncopal patients with chronic BBB and reduced EF (less than 45%), EP-induced VT is present in up to 42% (184,214,215). In patients with syncope and BBB, falsenegative EP studies are common (216,217).…”

Section: Electrophysiological Testing When Bradyarrhythmia Is Suspectedmentioning

confidence: 99%

ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death

Zipes¹,

Camm²,

Borggrefe³

et al. 2006

Circulation

1,198

671

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“…However, an echocardiogram must be obtained to evaluate for LV dysfunction or other structural heart disease as this may necessitate an ICD. 58 PPM is also indicated in patients with bradycardia and syncope in the setting of SND. RV pacing alone should be minimized whenever possible.…”

Section: Bradyarrhythmiasmentioning

confidence: 99%

Evaluation and Management of Syncope

Bindra

Marchlinski

Lin

2008

Clinical medicine. Circulatory, respiratory and pulmonary medic

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Context Syncope is a commonly encountered by primary care physicians and cardiologists. Etiology is frequently not apparent, and patients may undergo unnecessary tests. Treatment must be tailored to the likely etiology. Complexities of diagnosis and treatment often warrant referral to a specialist. Objective To highlight the evolving recommendations for managing syncope in a clinically and cost effective manner. Evidence Acquisition An electronic literature search was undertaken of the Medline database from January 1996 to April 2006, using the Medical Subject Heading syncope, defibrillators, pacemakers, echocardiogram, cardiomyopathy, long QT syndrome, Arrhythmogenic right ventricular dysplasia, and Brugada syndrome. Abstracts and titles were reviewed to identify English-language trials. Bibliographies from the references as well as scientific statements from the Heart Rhythm Society, American Heart Association, and American College of Cardiology were reviewed. Evidence Synthesis A methodical approach to syncope can improve diagnosis, limit testing, and identify patients at risk of fatal outcome. A thorough history, physical exam and electrocardiogram are critical to the initial diagnosis. Presence of heart disease determines the extent of work-up and treatment. A trans-thoracic echocardiogram should be performed in patients with an unclear diagnosis and a positive cardiac history or an abnormal ECG. Ventricular arrhythmias are the most common cause of syncope in patients with structural heart disease. Patients with an ejection fraction less than 30 percent should receive an implantable defibrillator with few exceptions. An electrophysiology study may assist risk stratification in syncopal patients with borderline ventricular function. In patients without structural heart disease, the presence of a well defined arrhythmia syndrome consistent with a genetically determined risk of sudden death must be sought. The 12-lead electrocardiogram, family history and clinical presentation will identify most high-risk patients. Patients without structural heart disease can often be managed conservatively with well defined strategies for preventing neurocardiogenic syncope. Conclusions Managing syncope requires a methodical approach. An understanding of the limitations of the diagnostic tools and treatments is important. Lethal causes of syncope make it imperative to recognize the appropriate timing of referring patients to specialists.

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Electrophysiologic testing in bundle branch block and unexplained syncope

Cited by 129 publications

References 20 publications

ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities

ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities

ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death

Evaluation and Management of Syncope

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