Predictors of Advanced His-Purkinje Conduction Disturbances in Patients With Unexplained Syncope and Bundle Branch Block

Boulé, Stéphane; Ouadah, A.; Langlois, Carole; Botcherby, Edward; Verbrugge, Eric; Huchette, David; Salleron, Julia; Kara, Meriem Mostefa; Kouakam, Claude; Brigadeau, François; Klug, Didier; Marquié, Christelle; Guédon‐Moreau, Laurence; Wissocque, Ludivine; Escande, William; Lacroix, Dominique; Kacet, Salem

doi:10.1016/j.cjca.2014.03.040

Cited by 10 publications

(13 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In our series, the diagnostic yield of EPS for bradyarrhythmia in patients with syncope and BBB is moderate (41.7%). This rate is comparable with other series with a variation between 38% and 42%. As far as we know this is the largest prospective single‐center study that analyses the diagnostic yield and predictors of electrophysiological (EP) positivity in patients with syncope and wide QRS.…”

Section: Discussionsupporting

confidence: 90%

“…Finally, the conduction disturbance pattern as predictor of positive EPS has been analyzed in a contemporary study. In this study, isolated RBBB had similar diagnostic yield (34.4%) than RBBB plus LAFB (36.2%, P = 0.05) or LBBB (46.2%, P = 0.29). In our series, number of patients with isolated RBBB (52 vs 33, respectively) and number of patients with RBBB + LAFB (102 vs 66, respectively) is larger than in the previous study .…”

Section: Discussionsupporting

confidence: 51%

“…In this study, isolated RBBB had similar diagnostic yield (34.4%) than RBBB plus LAFB (36.2%, P = 0.05) or LBBB (46.2%, P = 0.29). In our series, number of patients with isolated RBBB (52 vs 33, respectively) and number of patients with RBBB + LAFB (102 vs 66, respectively) is larger than in the previous study . Therefore, the lack of statistical power of the above‐mentioned study could be the explanation for these differences.…”

Section: Discussionsupporting

confidence: 51%

“…However, the location of AV block in case of BBB and long PR interval could be in both AV node or intra or below His bundle. 17 Many studies confirmed that long PR interval in case of BBB is associated with multisite conduction delay with involvement of His‐Purkinje system in a high proportion of patients . In contrast to QRS duration, long PR interval was associated with higher rate of positive EP test in both RBBB (positive EP test 59 vs 17.1%, OR 3.8; 1.7‐8.7; P < 0.0001), and LBBB (positive EP test 80.8 vs 40.9%, OR 5.2; 1.52‐17.74; P < 0.0001).…”

Section: Discussionmentioning

confidence: 95%

“…There are very few data on predictors of positivity of EPS among patients with syncope and BBB. Only first‐degree AV block is suggested as marker of higher positivity EPS rate. The aim of this study is to identify clinical and ECG predictors of positive EPS for bradyarrhythmia.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Predictors of positive electrophysiological study in patients with syncope and bundle branch block: PR interval and type of conduction disturbance

Roca‐Luque

Oristrell

Francisco-Pasqual

et al. 2018

Clinical Cardiology

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 51%

Section: Discussionsupporting

confidence: 51%

Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations