Syncope, conduction disturbance, and negative electrophysiological test: Predictive factors and risk score to predict pacemaker implantation during follow-up

Roca‐Luque, Ivo; Francisco‐Pascual, Jaume; Oristrell, Gerard; Rodríguez-García, Julián; Santos‐Ortega, Alba; Martin-Sanchez, Gabriel; Rivas-Gándara, Núria; Pérez-Rodón, Jordi; Ferreira‐González, Ignacio; Garcı́a-Dorado, David; Moya-Mitjans, Àngel

doi:10.1016/j.hrthm.2018.12.015

Cited by 20 publications

(24 citation statements)

References 27 publications

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“…Although an insertable Holter monitor would help clarify which patients need a pacemaker, this usually involves a new syncopal attack, and this might have serious consequences, especially in elderly patients 23 . Furthermore, the cost of this strategy is evident 17,24 , given the fact that 86% of patients in our study finally needed a pacemaker. This is consistent with the findings of previous studies 2 where pacemakers were implanted in 70% of patients with syncope of unknown origin and BFB.…”

Section: Discussionmentioning

confidence: 90%

“…However, the sensitivity of EPS to detect patients at risk of AV block during follow-up is low 4 . In a recent work by Roca-Luque et al 17 , almost 25% of patients with negative EPS developed advanced AV block during a 25 month follow-up period, requiring, thus, a pacemaker. Interestingly, this proportion seemed to be lower when the EPS was performed under flecainide than under procainamide.…”

Section: Discussionmentioning

confidence: 94%

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Syncope and bifascicular block in the absence of structural heart disease

Cabrera-Ramos

Jordán-Martínez

Jiménez‐Jáimez

et al. 2020

Sci Rep

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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. Management of patients with syncope of unknown origin and bifascicular block (BBF) without significant structural heart disease remains a matter of debate. According to current European guidelines, an electrophysiology study (EPS) should be performed as initial approach and an event recorder or permanent pacemaker implanted based upon the results 1,2. However, this recommendation is not supported by large or prospective studies, and some authors postulate the potential benefit of a direct pacemaker implant giving the 40-50% reported incidence of atrioventricular (AV) block in the 2 years post-EPS 2-4. There is lack of prospective information regarding the clinical benefit of an empirical pacing approach compared to a treatment based on EPS results, in patients without structural heart disease. Our aim is to compare the clinical outcome of patients with syncope of unknown etiology and BFB without significant structural heart disease treated empirically with permanent pacemaker implantation compared to those whose treatment approach was based on the results of an EPS. Methods Patients and treatment algorithm. We designed a cohort study with prospective follow-up to include patients presenting with unexplained syncope and BFB defined as left bundle branch block, or right bundle branch block plus left anterior or posterior fascicular block. Patients signed a written informed consent. The study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki as reflected in a priori approval by the institution's human research committee (The Clinical Research Ethics Committee of Granada (CEIC). Patients were excluded from the study in case of structural heart disease, defined as interventricular septal wall thickness >13 mm, left ventricular ejection fraction <50%, valvular heart disease ≥ grade 2, or ECG and cardiac imaging findings suggestive of arrhythmogenic cardiomyopathy 5 (Patients who met diagnostic criteria for arrhythmogenic dysplasia of the right ventricle, two major criteria, one major and two minor or four minor were excluded). Patients were also excluded if they fulfilled ECG criteria...

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 94%

Syncope and bifascicular block in the absence of structural heart disease

Cabrera-Ramos

Jordán-Martínez

Jiménez‐Jáimez

et al. 2020

Sci Rep

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“…Monitoring of rhythm and blood pressure, timely checking immediate ECG, dynamic electrocardiogram, etc. were reported to reduce the risk of syncope (Ng et al, 2019 ; Probst et al, 2020 ; Roca‐Luque et al, 2019 ; Russo et al, 2018 ; Thiruganasambandamoorthy et al, 2020 ). Univariate analysis showed that the prognosis of syncope was related to age ≥60 years old, hypertension, positive troponin T, abnormal electrocardiogram, and coronary heart disease.…”

Section: Discussionmentioning

confidence: 99%

Etiology, risk factors, and prognosis of patients with syncope: A single‐center analysis

Lin

Feng

Xue

et al. 2021

Noninvasive Electrocardiol

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Objective To investigate the main causes, risk factors, and prognosis of patients hospitalized with syncope. Methods The patients admitted due to syncope were included. We analyzed the etiology, risk factors, and prognosis of patients with an average follow‐up of 15.3 months. Results High‐risk factors for cardiogenic syncope included age ≥60, male, hypertension, palpitation, troponin T‐positive, abnormal ECG, CHD history, and syncope‐related trauma. Mortality rate was 4.6%, recurrence rate of syncope was 10.5%, and the rehospitalization rate was 8.5%. Univariate analysis showed that prognosis of syncope was related to age ≥60 years old, hypertension, positive troponin T, abnormal electrocardiogram, and coronary heart disease (p < .05). Multivariate Cox proportional hazard analysis showed that age ≥60 years old (p = .021) and high‐sensitivity troponin‐positive (p = .024) were strongly related to the prognosis of syncope. Kaplan–Meier curve showed statistical difference in the survival rate between the groups divided by age ≥60 years (p = .028), hs‐TnT‐positive (p < .001), abnormal ECG (p = .027), and history of CHD (p = .020). Conclusion High‐risk factors for cardiogenic syncope included age ≥60, male, hypertension, palpitation, troponin T‐positive, abnormal ECG, CHD family history, and syncope‐related trauma. Age, hypertension, troponin T‐positive, abnormal ECG, and CHD history were associated with the prognosis of syncope.

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“…In recent years, there has been abundant literature on the diagnostic yield of implantable recording devices. The greatest experience with this kind of device concerns patients with syncope of unknown etiology[ 10 - 12 ], given the long monitoring time that they offer, with diagnostic yield figures around 35%[ 9 , 18 , 30 , 70 ]. There are also numerous papers analyzing the role of ILRs in patients with stroke of unknown etiology, and, as with ELRs, it has been shown that the strategy of implanting an ILR leads to a greater and earlier diagnosis rate than following a conventional strategy[ 49 , 80 ].…”

Section: Electrocardographic Cardiac Monitoring Devicesmentioning

confidence: 99%

“…The introduction of the 24-h Holter monitor within 60 s was a true revolution and its use rapidly became widespread[ 6 ]. Other than diagnosing palpitations, it has also been an important tool in understanding the physiological cardiac rhythm behavior[ 7 , 8 ] and in the follow-up of patients at risk of cardiovascular disease[ 8 ], in syncope work-up[ 9 - 12 ], in risk stratification of certain patients[ 13 - 16 ] or in the detection of silent arrhythmias[ 8 , 17 - 21 ]. Due to its high availability and probably due to a certain degree of tradition, it is the monitoring system most commonly used by most doctors.…”

Section: Introductionmentioning

confidence: 99%

Cardiac monitoring for patients with palpitations

Francisco‐Pascual¹,

Cantalapiedra-Romero²,

Pérez-Rodón³

et al. 2021

WJC

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Palpitations are one of the most common reasons for medical consultation. They tend to worry patients and can affect their quality of life. They are often a symptom associated with cardiac rhythm disorders, although there are other etiologies. For diagnosis, it is essential to be able to reliably correlate the symptoms with an electrocardiographic record allowing the identification or ruling out of a possible rhythm disorder. However, reaching a diagnosis is not always simple, given that they tend to be transitory symptoms and the patient is frequently asymptomatic at the time of assessment. In recent years, electrocardiographic monitoring systems have incorporated many technical improvements that solve several of the 24-h Holter monitor limitations. The objective of this review is to provide an update on the different monitoring methods currently available, remarking their indications and limitations, to help healthcare professionals to appropriately select and use them in the work-up of patients with palpitations.

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Syncope, conduction disturbance, and negative electrophysiological test: Predictive factors and risk score to predict pacemaker implantation during follow-up

Cited by 20 publications

References 27 publications

Syncope and bifascicular block in the absence of structural heart disease

Syncope and bifascicular block in the absence of structural heart disease

Etiology, risk factors, and prognosis of patients with syncope: A single‐center analysis

Cardiac monitoring for patients with palpitations

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