Sex-Related Differences in Patients With Unexplained Syncope and Bundle Branch Block: Lower Risk of AV Block and Lesser Need for Cardiac Pacing in Women

Francisco‐Pascual, Jaume; Rivas-Gándara, Núria; Bach-Oller, Montserrat; Badia-Molins, Clara; Maymi-Ballesteros, Manel; Benito, Begoña; Pérez-Rodón, Jordi; Santos‐Ortega, Alba; Sambola-Ayala, Antonia; Roca‐Luque, Ivo; Cantalapiedra-Romero, Javier; Rodríguez-Silva, Jesús; Pascual-González, Gabriel; Moya-Mitjans, Àngel; Ferreira‐González, Ignacio

doi:10.3389/fcvm.2022.838473

Cited by 10 publications

(9 citation statements)

References 33 publications

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“…This study found that the diagnostic approach is safe and achieves a high rate of etiological diagnosis allowing for the selection of specific treatment and avoiding the implantation of unnecessary pacemakers. The results of the B4 study have been confirmed by several subsequent studies, some of them with a relatively high number of patients and long-term follow-up[ 80 , 108 , 132 - 134 ].…”

Section: Arrhythmic Syncope In Specific Populationsmentioning

confidence: 54%

Arrhythmic syncope: From diagnosis to management

Pascual¹,

Marchite²,

Silva³

et al. 2023

World J Cardiol

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Syncope is a concerning symptom that affects a large proportion of patients. It can be related to a heterogeneous group of pathologies ranging from trivial causes to diseases with a high risk of sudden death. However, benign causes are the most frequent, and identifying high-risk patients with potentially severe etiologies is crucial to establish an accurate diagnosis, initiate effective therapy, and alter the prognosis. The term cardiac syncope refers to those episodes where the cause of the cerebral hypoperfusion is directly related to a cardiac disorder, while arrhythmic syncope is cardiac syncope specifically due to rhythm disorders. Indeed, arrhythmias are the most common cause of cardiac syncope. Both bradyarrhythmia and tachyarrhythmia can cause a sudden decrease in cardiac output and produce syncope. In this review, we summarized the main guidelines in the management of patients with syncope of presumed arrhythmic origin. Therefore, we presented a thorough approach to syncope work-up through different tests depending on the clinical characteristics of the patients, risk stratification, and the management of syncope in different scenarios such as structural heart disease and channelopathies.

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Section: Arrhythmic Syncope In Specific Populationsmentioning

confidence: 54%

Arrhythmic syncope: From diagnosis to management

Pascual¹,

Marchite²,

Silva³

et al. 2023

World J Cardiol

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“…We assessed 37 studies by full‐text review. Finally, 5 prospective 12 , 21 , 22 , 23 , 24 and 5 retrospective 25 , 26 , 27 , 28 , 29 observational studies were included.…”

Section: Resultsmentioning

confidence: 99%

“…As it shown in Table 1 , four studies were conducted in Japan 22 , 27 and Spain. 23 , 24 Other article's origins were Canada, 21 South Korea, 29 Italy, 28 Germany, 25 Slovakia, 26 and Australia. 12 The follow‐up time ranged from 3 months to over 3 years.…”

Section: Resultsmentioning

confidence: 99%

“…Only a few studies have identified HTN as a risk factor for the implantation of pacing devices, however HTN was more prevalent among patients that required pacemaker implantation according to data from other studies. 12,23,25,26,29,50 Reyhane Yahya and Shayan Bastami: performed quality assessment.…”

Section: Discussionmentioning

confidence: 99%

“…HTN, similar to diabetes was found to be an insignificant independent predictive factor for pacemaker implantation. Only a few studies have identified HTN as a risk factor for the implantation of pacing devices, however HTN was more prevalent among patients that required pacemaker implantation according to data from other studies 12,23,25,26,29,50 . it's important to note that, based on the SPRINT trial, among hypertensive patients, aggressive HTN treatment compared to standard treatment was more associated with the occurrence of syncope 51 .…”

Section: Discussionmentioning

confidence: 99%

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Predictors of pacemaker requirement in patients with implantable loop recorder and unexplained syncope: A systematic review and meta‐analysis

Zangiabadian,

Soltani,

Gholinejad

et al. 2024

Clinical Cardiology

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Identifying the underlying cause of unexplained syncope is crucial for appropriate management of recurrent syncopal episodes. Implantable loop recorders (ILRs) have emerged as valuable diagnostic tools for monitoring patients with unexplained syncope. However, the predictors of pacemaker requirement in patients with ILR and unexplained syncope remain unclear. In this study, we shed light on these prognostic factors. PubMed/MEDLINE, EMBASE, Web of Science, and Cochrane CENTRAL were systematically searched until May 04, 2023. Studies that evaluated the predictors of pacemaker requirement in patients with implantable loop recorder and unexplained syncope were included. The “Quality In Prognosis Studies” appraisal tool was used for quality assessment. The pooled odds ratio (OR) with 95% confidence intervals (CIs) was calculated. The publication bias was evaluated using Egger's and Begg's tests. Ten studies (n = 4200) were included. Right bundle branch block (OR: 3.264; 95% CI: 1.907–5.588, p < .0001) and bifascicular block (OR: 2.969; 95% CI: 1.859–4.742, p < .0001) were the strongest predictors for pacemaker implantation. Pacemaker requirement was more than two times in patients with atrial fibrillation, sinus bradycardia and first degree AV block. Valvular heart disease, diabetes mellitus, and hypertension were also significantly more in patients with pacemaker implantation. Age (standardized mean difference [SMD]: 0.560; 95% CI: 0.410/0.710, p < .0001) and PR interval (SMD: 0.351; 95% CI: 0.150/0.553, p = .001) were significantly higher in patients with pacemaker requirement. Heart conduction disorders, atrial arrhythmias and underlying medical conditions are main predictors of pacemaker device implantation following loop recorder installation in unexplained syncopal patients.

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