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Ravi SN, Cheema KP, Taylor GE. 52-Year-Old Woman With Recurrent Unexplained Syncope. Mayo Clin Proc 2024:S0025-6196(23)00468-8. [PMID: 38829292 DOI: 10.1016/j.mayocp.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 06/05/2024]
Affiliation(s)
- Srekar N Ravi
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Phoenix, AZ
| | - Kamal Preet Cheema
- Fellow in Cardiovascular Diseases, Mayo Clinic School of Graduate Medical Education, Phoenix, AZ
| | - Gretchen E Taylor
- Advisor to resident and fellow and Consultant in Hospital Internal Medicine, Mayo Clinic, Phoenix, AZ.
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Neira V, Enriquez A, Sheldon R, Hanson MG, Maxey C, Baranchuk A. Impact of bundle branch block morphology on outcomes of patients with syncope and bifascicular block: A SPRITELY (POST 3) substudy. Heart Rhythm 2023; 20:31-36. [PMID: 36184061 DOI: 10.1016/j.hrthm.2022.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/15/2022] [Accepted: 09/22/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Permanent pacing is often considered for patients with syncope and bifascicular block. OBJECTIVE The purpose of this study was to determine whether QRS morphology or other electrocardiographic characteristics can identify patients who may benefit from permanent pacing. METHODS The Syncope: Pacing or Recording in the Later Years (SPRITELY) trial was a multicenter trial that randomized patients with bifascicular block and syncope (n = 115) to empiric pacemaker implantation vs implantable loop recorder (ILR) monitoring. In this SPRITELY subanalysis, baseline 12-lead electrocardiograms were evaluated for bundle branch block (BBB) morphology, QRS width, and PR and QT intervals and their impact on clinical outcomes was assessed. RESULTS There were 41 patients with left BBB (36%), 69 patients with right bundle branch block (RBBB) and left anterior fascicular block (60%), and 5 patients with RBBB and left posterior fascicular block (4%). Pacemaker implant compared with ILR was associated with a significant reduction of major study-related events (MSREs) in both patients with left BBB (23.8% vs 78.9%; P = .001) and those with RBBB (27% vs 72.9%; P < .0001). Similarly, a reduction of MSREs was observed in both patients with trifascicular block (23% vs 84.6%; P < .0001) and those with bifascicular block (26.6% vs 68.9%; P = .002). In the group randomized to ILR monitoring, the type of BBB was not a predictor of recurrent syncope (P = .30), bradycardia requiring pacemaker (P = .15), or MSREs (P = .42). The presence of PR interval prolongation or QRS width in this group did not predict MSREs (P = .22 and P = .96, respectively). CONCLUSION In patients with syncope and bifascicular block, pacemaker implantation reduces adverse events as compared with ILR monitoring, irrespective of the type of BBB or the presence of PR interval prolongation.
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Affiliation(s)
- Victor Neira
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Andres Enriquez
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Robert Sheldon
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Matthew G Hanson
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Connor Maxey
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Adrian Baranchuk
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada.
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3
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Cao YW, Wu HY. Cause of Recurrent Syncope in an Elderly Patient. JAMA Intern Med 2022; 182:870-871. [PMID: 35696256 DOI: 10.1001/jamainternmed.2022.2016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Yi-Wei Cao
- Department of Electrocardiology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi Province, China
| | - Hao-Yu Wu
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi Province, China
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4
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2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Translation of the document prepared by the Czech Society of Cardiology. COR ET VASA 2022. [DOI: 10.33678/cor.2022.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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5
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJ, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM. Grupo de trabajo sobre estimulación cardiaca y terapia de resincronización cardiaca de la Sociedad Europea de Cardiología (ESC). Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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6
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM, Leyva F, Linde C, Abdelhamid M, Aboyans V, Arbelo E, Asteggiano R, Barón-Esquivias G, Bauersachs J, Biffi M, Birgersdotter-Green U, Bongiorni MG, Borger MA, Čelutkienė J, Cikes M, Daubert JC, Drossart I, Ellenbogen K, Elliott PM, Fabritz L, Falk V, Fauchier L, Fernández-Avilés F, Foldager D, Gadler F, De Vinuesa PGG, Gorenek B, Guerra JM, Hermann Haugaa K, Hendriks J, Kahan T, Katus HA, Konradi A, Koskinas KC, Law H, Lewis BS, Linker NJ, Løchen ML, Lumens J, Mascherbauer J, Mullens W, Nagy KV, Prescott E, Raatikainen P, Rakisheva A, Reichlin T, Ricci RP, Shlyakhto E, Sitges M, Sousa-Uva M, Sutton R, Suwalski P, Svendsen JH, Touyz RM, Van Gelder IC, Vernooy K, Waltenberger J, Whinnett Z, Witte KK. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Europace 2022; 24:71-164. [PMID: 34455427 DOI: 10.1093/europace/euab232] [Citation(s) in RCA: 111] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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7
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Affiliation(s)
- Yi-Wei Cao
- Department of Electrocardiology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi Province, China
| | - Fan Wang
- Department of Cardiology, Taian City Central Hospital, Taian, Shandong Province, China
| | - Hao-Yu Wu
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi Province, China
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8
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J 2021; 42:3427-3520. [PMID: 34455430 DOI: 10.1093/eurheartj/ehab364] [Citation(s) in RCA: 783] [Impact Index Per Article: 261.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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9
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Erkapic D, Frommeyer G, Brettner N, Sözener K, Crijns HJGM, Seyfarth M, Hamm CW, Bogossian H. QTc interval evaluation in patients with right bundle branch block or bifascicular blocks. Clin Cardiol 2020; 43:957-962. [PMID: 32427380 PMCID: PMC7462182 DOI: 10.1002/clc.23389] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/03/2020] [Accepted: 05/04/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The right bundle branch block (RBBB) and the bifascicular blocks affect QRS duration in the right precordial leads, which are usually used for QT interval determination. Up to now, there is no clear recommendation how to determine QT interval in patients with RBBB or bifascicular block. HYPOTHESIS The hypothesis of the present study was to evaluate the feasibility of a simple formula for RBBB and bifascicular block correction, thereby making it easier to determine the QTc interval. METHODS In patients with intrinsic QRS duration <120 ms, artificial RBBB with either left posterior (LPFB) or left anterior fascicular block (LAFB), created by left ventricular pacing maneuvers, were corrected using the Bogossian formula (QTm) and afterward were heart rate corrected (QTmc). Heart rate correction was performed using different heart rate formulas in comparison to each other. The QTmc intervals were compared in each patient with the QTc interval during intrinsic rhythm. RESULTS A total of scheduled 71 patients were included in this prospective multicenter observational comparative study. Compared to intrinsic QTc interval, the mean ΔQTmc interval by combination of the Bogossian and the Hodge formulas was -3 ± 24 ms in RBBB + LPFB (P = .44) and -6 ± 25 ms in RBBB + LAFB (P = .15). The Bogossian formula showed a significant deviation from the actual QTc interval with both the Bazett and the Fridericia formulas. CONCLUSION In combination with the Hodge formula, the Boggosian formula delivered the best results in comparing the true QTc interval in narrow QRS with the QTmc interval in the presence of a bifascicular block.
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Affiliation(s)
- Damir Erkapic
- Diakonie Klinikum SiegenDepartment of Cardiology and ElectrophysiologySiegenGermany
- Department of Cardiology and AngiologyUniversity Clinic of Gießen, Medical Clinic IGießenGermany
| | - Gerrit Frommeyer
- Clinic for Cardiology II – ElectrophysiologyUniversity Clinic of MünsterMünsterGermany
| | - Niklas Brettner
- Department of Cardiology and AngiologyUniversity Clinic of Gießen, Medical Clinic IGießenGermany
| | - Korkut Sözener
- Diakonie Klinikum SiegenDepartment of Cardiology and ElectrophysiologySiegenGermany
| | - Harry J. G. M. Crijns
- Department of Cardiology, Maastricht University Medical Center (MUMC+) and Cardiovascular Research, Institute Maastricht (CARIM)MaastrichtThe Netherlands
| | - Melchior Seyfarth
- Department of CardiologyHelios Klinikum WuppertalWuppertalGermany
- Department of CardiologyUniversity Witten/HerdeckeWittenGermany
| | - Christian W. Hamm
- Department of Cardiology and AngiologyUniversity Clinic of Gießen, Medical Clinic IGießenGermany
| | - Harilaos Bogossian
- Department of Cardiology, Maastricht University Medical Center (MUMC+) and Cardiovascular Research, Institute Maastricht (CARIM)MaastrichtThe Netherlands
- Department of CardiologyUniversity Witten/HerdeckeWittenGermany
- Department of Cardiology and RhythmologyEv. Krankenhaus HagenHagenGermany
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Rivera-López R, Cabrera-Ramos M, Jordán-Martinez L, Jimenez-Jaimez J, Macias-Ruiz R, Aguilar-Alonso E, Rivera-Fernandez R, Sanchez-Cantalejo E, Tercedor L, Alvarez M. Syncope and bifascicular block in the absence of structural heart disease. Sci Rep 2020; 10:8139. [PMID: 32424127 PMCID: PMC7235078 DOI: 10.1038/s41598-020-65088-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 04/23/2020] [Indexed: 11/09/2022] Open
Abstract
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.
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Affiliation(s)
- Ricardo Rivera-López
- Cardiology Department, Hospital Universitario Virgen de las Nieves. Granada, Granada, Spain.,Granada Institute of Biohealth Research (Granada. Ibs), Granada, Spain
| | - Mercedes Cabrera-Ramos
- Cardiology Department, Hospital Universitario Virgen de las Nieves. Granada, Granada, Spain
| | - Laura Jordán-Martinez
- Cardiology Department, Hospital Universitario Virgen de las Nieves. Granada, Granada, Spain.,Granada Institute of Biohealth Research (Granada. Ibs), Granada, Spain
| | - Juan Jimenez-Jaimez
- Cardiology Department, Hospital Universitario Virgen de las Nieves. Granada, Granada, Spain.,Granada Institute of Biohealth Research (Granada. Ibs), Granada, Spain
| | - Rosa Macias-Ruiz
- Cardiology Department, Hospital Universitario Virgen de las Nieves. Granada, Granada, Spain.,Granada Institute of Biohealth Research (Granada. Ibs), Granada, Spain
| | | | | | - Emilio Sanchez-Cantalejo
- Granada Institute of Biohealth Research (Granada. Ibs), Granada, Spain.,Andalusian School of Public Health, Granada, Spain.,Epidemiology and Public Health Network Biomedical Research Consortium (CIBERESP), Madrid, Spain
| | - Luis Tercedor
- Cardiology Department, Hospital Universitario Virgen de las Nieves. Granada, Granada, Spain.,Granada Institute of Biohealth Research (Granada. Ibs), Granada, Spain
| | - Miguel Alvarez
- Cardiology Department, Hospital Universitario Virgen de las Nieves. Granada, Granada, Spain.,Granada Institute of Biohealth Research (Granada. Ibs), Granada, Spain
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11
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Syncope, conduction disturbance, and negative electrophysiological test: Predictive factors and risk score to predict pacemaker implantation during follow-up. Heart Rhythm 2019; 16:905-912. [PMID: 30576876 DOI: 10.1016/j.hrthm.2018.12.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Indexed: 12/27/2022]
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12
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Muresan L, Cismaru G, Martins RP, Bataglia A, Rosu R, Puiu M, Gusetu G, Mada RO, Muresan C, Ispas DR, Le Bouar R, Diene LL, Rugina E, Levy J, Klein C, Sellal JM, Poull IM, Laurent G, de Chillou C. Recommendations for the use of electrophysiological study: Update 2018. Hellenic J Cardiol 2018; 60:82-100. [PMID: 30278230 DOI: 10.1016/j.hjc.2018.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 08/31/2018] [Accepted: 09/24/2018] [Indexed: 12/16/2022] Open
Abstract
The field of cardiac electrophysiology has greatly developed during the past decades. Consequently, the use of electrophysiological studies (EPSs) in clinical practice has also significantly augmented, with a progressively increasing number of certified electrophysiology centers and specialists. Since Zipes et al published the Guidelines for Clinical Intracardiac Electrophysiology and Catheter Ablation Procedures in 1995, no official document summarizing current EPS indications has been published. The current paper focuses on summarizing all relevant data of the role of EPS in patients with different types of cardiac pathologies and provides up-to-date recommendations on this topic. For this purpose, the PubMed database was screened for relevant articles in English up to December 2018 and ESC and ACC/AHA Clinical Practice Guidelines, and EHRA/HRS/APHRS position statements related to the current topic were analyzed. Current recommendations for the use of EPS in clinical practice are discussed and presented in 17 distinct cardiac pathologies. A short rationale, evidence, and indications are provided for each cardiac disease/group of diseases. In conclusion, because of its capability to establish a diagnosis in patients with a variety of cardiac pathologies, the EPS remains a useful tool in the evaluation of patients with cardiac arrhythmias and conduction disorders and is capable of establishing indications for cardiac device implantation and guide catheter ablation procedures.
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Affiliation(s)
- Lucian Muresan
- "Emile Muller" Hospital, Cardiology Department, 68100 Mulhouse, France.
| | - Gabriel Cismaru
- Rehabilitation Hospital, Cardiology Department, 400347 Cluj-Napoca, Romania
| | - Raphaël Pedro Martins
- Centre Hospitalier Universitaire de Rennes, Cardiology Department, 35000 Rennes, France
| | - Alberto Bataglia
- Institut Lorrain du Coeur et des Vaisseaux « Louis Mathieu », Cardiology Department, Electrophysiology Department, 54000 Vandoeuvre-les-Nancy, France
| | - Radu Rosu
- Rehabilitation Hospital, Cardiology Department, 400347 Cluj-Napoca, Romania
| | - Mihai Puiu
- Rehabilitation Hospital, Cardiology Department, 400347 Cluj-Napoca, Romania
| | - Gabriel Gusetu
- Rehabilitation Hospital, Cardiology Department, 400347 Cluj-Napoca, Romania
| | - Razvan Olimpiu Mada
- "Niculae Stancioiu" Heart Institute, Cardiology Department, 400005 Cluj-Napoca, Romania
| | - Crina Muresan
- "Emile Muller" Hospital, Cardiology Department, 68100 Mulhouse, France
| | - Daniel Radu Ispas
- Rehabilitation Hospital, Cardiology Department, 400347 Cluj-Napoca, Romania
| | - Ronan Le Bouar
- "Emile Muller" Hospital, Cardiology Department, 68100 Mulhouse, France
| | | | - Elena Rugina
- "Emile Muller" Hospital, Cardiology Department, 68100 Mulhouse, France
| | - Jacques Levy
- "Emile Muller" Hospital, Cardiology Department, 68100 Mulhouse, France
| | - Cedric Klein
- Centre Hospitalier Universitaire de Lille, Cardiology Department, 59000 Lille, France
| | - Jean Marc Sellal
- Institut Lorrain du Coeur et des Vaisseaux « Louis Mathieu », Cardiology Department, Electrophysiology Department, 54000 Vandoeuvre-les-Nancy, France
| | - Isabelle Magnin Poull
- Institut Lorrain du Coeur et des Vaisseaux « Louis Mathieu », Cardiology Department, Electrophysiology Department, 54000 Vandoeuvre-les-Nancy, France
| | - Gabriel Laurent
- Centre Hospitalier Universitaire de Dijon, Cardiology Department, 21000 Dijon, France
| | - Christian de Chillou
- Institut Lorrain du Coeur et des Vaisseaux « Louis Mathieu », Cardiology Department, Electrophysiology Department, 54000 Vandoeuvre-les-Nancy, France
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Brignole M, Moya A, de Lange FJ, Deharo JC, Elliott PM, Fanciulli A, Fedorowski A, Furlan R, Kenny RA, Martín A, Probst V, Reed MJ, Rice CP, Sutton R, Ungar A, van Dijk JG. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J 2018; 39:1883-1948. [PMID: 29562304 DOI: 10.1093/eurheartj/ehy037] [Citation(s) in RCA: 935] [Impact Index Per Article: 155.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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14
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Santucci P. Electrophysiology testing and pacing in octogenarians with unexplained syncope—time to reconsider? Heart Rhythm 2017; 14:700-701. [DOI: 10.1016/j.hrthm.2017.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Indexed: 10/20/2022]
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15
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Testa L, Latib A, De Marco F, De Carlo M, Agnifili M, Latini RA, Petronio AS, Ettori F, Poli A, De Servi S, Ramondo A, Napodano M, Klugmann S, Ussia GP, Tamburino C, Brambilla N, Colombo A, Bedogni F. Clinical Impact of Persistent Left Bundle-Branch Block After Transcatheter Aortic Valve Implantation With CoreValve Revalving System. Circulation 2013; 127:1300-7. [DOI: 10.1161/circulationaha.112.001099] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Conduction disturbances are relatively common after transcatheter aortic valve implantation. Previous data demonstrated an adverse impact of persistent left bundle-branch block (LBBB) after surgical aortic valve replacement. It is unclear whether new-onset LBBB may also impact the prognosis of patients after transcatheter aortic valve implantation.
Methods and Results—
Among 1060 patients treated with a CoreValve Revalving System transcatheter aortic valve implantation between October 2007 and April 2011 in high-volume centers in Italy, we analyzed those without LBBB or pacemaker at admission (879 patients [82.9%]). We further excluded those who underwent permanent pacemaker implantation within 48 hours after the procedure (61 patients [7%]), for a final study population of 818 patients. Among them, 224 patients (group A; 27.4%) developed a persistent LBBB and the remaining 594 (group B; 72.6%) did not. Clinical characteristics were similar between groups. A low implantation was significantly more frequent in group A (15% versus 9.8%,
P
=0.02). No patients were censored before 1 year (median follow-up period 438 days, interquartile range 174–798 days). Survival analyses and inherent log-rank tests showed that LBBB was not associated with higher all-cause mortality, cardiac mortality, or hospitalization for heart failure at 30 days or 1 year. At 30 days, but not at 1 year, group A had a significantly higher rate of pacemaker implantation.
Conclusions—
In this registry of high-volume centers, persistent LBBB after CoreValve Revalving System transcatheter aortic valve implantation showed no effect on hard end points. On the other hand, LBBB was associated with a higher short-term rate of pacemaker implantation.
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Affiliation(s)
- Luca Testa
- From the Department of Cardiology, Istituto Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy (L.T., M.A., R.A., N.B., F.B.); San Raffaele Hospital, Milan, Italy (A.L., S.K., A.C.); Niguarda Ca Granda Hospital, Milan, Italy (F.D.M.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (F.E.); Azienda Ospedaliera Legnano, Legnano, Italy (A.P., S.D.S.); Ospedale di Bassano del Grappa
| | - Azeem Latib
- From the Department of Cardiology, Istituto Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy (L.T., M.A., R.A., N.B., F.B.); San Raffaele Hospital, Milan, Italy (A.L., S.K., A.C.); Niguarda Ca Granda Hospital, Milan, Italy (F.D.M.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (F.E.); Azienda Ospedaliera Legnano, Legnano, Italy (A.P., S.D.S.); Ospedale di Bassano del Grappa
| | - Federico De Marco
- From the Department of Cardiology, Istituto Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy (L.T., M.A., R.A., N.B., F.B.); San Raffaele Hospital, Milan, Italy (A.L., S.K., A.C.); Niguarda Ca Granda Hospital, Milan, Italy (F.D.M.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (F.E.); Azienda Ospedaliera Legnano, Legnano, Italy (A.P., S.D.S.); Ospedale di Bassano del Grappa
| | - Marco De Carlo
- From the Department of Cardiology, Istituto Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy (L.T., M.A., R.A., N.B., F.B.); San Raffaele Hospital, Milan, Italy (A.L., S.K., A.C.); Niguarda Ca Granda Hospital, Milan, Italy (F.D.M.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (F.E.); Azienda Ospedaliera Legnano, Legnano, Italy (A.P., S.D.S.); Ospedale di Bassano del Grappa
| | - Mauro Agnifili
- From the Department of Cardiology, Istituto Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy (L.T., M.A., R.A., N.B., F.B.); San Raffaele Hospital, Milan, Italy (A.L., S.K., A.C.); Niguarda Ca Granda Hospital, Milan, Italy (F.D.M.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (F.E.); Azienda Ospedaliera Legnano, Legnano, Italy (A.P., S.D.S.); Ospedale di Bassano del Grappa
| | - Roberto Adriano Latini
- From the Department of Cardiology, Istituto Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy (L.T., M.A., R.A., N.B., F.B.); San Raffaele Hospital, Milan, Italy (A.L., S.K., A.C.); Niguarda Ca Granda Hospital, Milan, Italy (F.D.M.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (F.E.); Azienda Ospedaliera Legnano, Legnano, Italy (A.P., S.D.S.); Ospedale di Bassano del Grappa
| | - Anna Sonia Petronio
- From the Department of Cardiology, Istituto Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy (L.T., M.A., R.A., N.B., F.B.); San Raffaele Hospital, Milan, Italy (A.L., S.K., A.C.); Niguarda Ca Granda Hospital, Milan, Italy (F.D.M.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (F.E.); Azienda Ospedaliera Legnano, Legnano, Italy (A.P., S.D.S.); Ospedale di Bassano del Grappa
| | - Federica Ettori
- From the Department of Cardiology, Istituto Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy (L.T., M.A., R.A., N.B., F.B.); San Raffaele Hospital, Milan, Italy (A.L., S.K., A.C.); Niguarda Ca Granda Hospital, Milan, Italy (F.D.M.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (F.E.); Azienda Ospedaliera Legnano, Legnano, Italy (A.P., S.D.S.); Ospedale di Bassano del Grappa
| | - Arnaldo Poli
- From the Department of Cardiology, Istituto Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy (L.T., M.A., R.A., N.B., F.B.); San Raffaele Hospital, Milan, Italy (A.L., S.K., A.C.); Niguarda Ca Granda Hospital, Milan, Italy (F.D.M.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (F.E.); Azienda Ospedaliera Legnano, Legnano, Italy (A.P., S.D.S.); Ospedale di Bassano del Grappa
| | - Stefano De Servi
- From the Department of Cardiology, Istituto Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy (L.T., M.A., R.A., N.B., F.B.); San Raffaele Hospital, Milan, Italy (A.L., S.K., A.C.); Niguarda Ca Granda Hospital, Milan, Italy (F.D.M.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (F.E.); Azienda Ospedaliera Legnano, Legnano, Italy (A.P., S.D.S.); Ospedale di Bassano del Grappa
| | - Angelo Ramondo
- From the Department of Cardiology, Istituto Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy (L.T., M.A., R.A., N.B., F.B.); San Raffaele Hospital, Milan, Italy (A.L., S.K., A.C.); Niguarda Ca Granda Hospital, Milan, Italy (F.D.M.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (F.E.); Azienda Ospedaliera Legnano, Legnano, Italy (A.P., S.D.S.); Ospedale di Bassano del Grappa
| | - Massimo Napodano
- From the Department of Cardiology, Istituto Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy (L.T., M.A., R.A., N.B., F.B.); San Raffaele Hospital, Milan, Italy (A.L., S.K., A.C.); Niguarda Ca Granda Hospital, Milan, Italy (F.D.M.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (F.E.); Azienda Ospedaliera Legnano, Legnano, Italy (A.P., S.D.S.); Ospedale di Bassano del Grappa
| | - Silvio Klugmann
- From the Department of Cardiology, Istituto Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy (L.T., M.A., R.A., N.B., F.B.); San Raffaele Hospital, Milan, Italy (A.L., S.K., A.C.); Niguarda Ca Granda Hospital, Milan, Italy (F.D.M.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (F.E.); Azienda Ospedaliera Legnano, Legnano, Italy (A.P., S.D.S.); Ospedale di Bassano del Grappa
| | - Gian Paolo Ussia
- From the Department of Cardiology, Istituto Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy (L.T., M.A., R.A., N.B., F.B.); San Raffaele Hospital, Milan, Italy (A.L., S.K., A.C.); Niguarda Ca Granda Hospital, Milan, Italy (F.D.M.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (F.E.); Azienda Ospedaliera Legnano, Legnano, Italy (A.P., S.D.S.); Ospedale di Bassano del Grappa
| | - Corrado Tamburino
- From the Department of Cardiology, Istituto Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy (L.T., M.A., R.A., N.B., F.B.); San Raffaele Hospital, Milan, Italy (A.L., S.K., A.C.); Niguarda Ca Granda Hospital, Milan, Italy (F.D.M.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (F.E.); Azienda Ospedaliera Legnano, Legnano, Italy (A.P., S.D.S.); Ospedale di Bassano del Grappa
| | - Nedy Brambilla
- From the Department of Cardiology, Istituto Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy (L.T., M.A., R.A., N.B., F.B.); San Raffaele Hospital, Milan, Italy (A.L., S.K., A.C.); Niguarda Ca Granda Hospital, Milan, Italy (F.D.M.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (F.E.); Azienda Ospedaliera Legnano, Legnano, Italy (A.P., S.D.S.); Ospedale di Bassano del Grappa
| | - Antonio Colombo
- From the Department of Cardiology, Istituto Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy (L.T., M.A., R.A., N.B., F.B.); San Raffaele Hospital, Milan, Italy (A.L., S.K., A.C.); Niguarda Ca Granda Hospital, Milan, Italy (F.D.M.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (F.E.); Azienda Ospedaliera Legnano, Legnano, Italy (A.P., S.D.S.); Ospedale di Bassano del Grappa
| | - Francesco Bedogni
- From the Department of Cardiology, Istituto Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy (L.T., M.A., R.A., N.B., F.B.); San Raffaele Hospital, Milan, Italy (A.L., S.K., A.C.); Niguarda Ca Granda Hospital, Milan, Italy (F.D.M.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (F.E.); Azienda Ospedaliera Legnano, Legnano, Italy (A.P., S.D.S.); Ospedale di Bassano del Grappa
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Santini M, Castro A, Giada F, Ricci R, Inama G, Gaggioli G, Calò L, Orazi S, Viscusi M, Chiodi L, Bartoletti A, Foglia-Manzillo G, Ammirati F, Loricchio ML, Pedrinazzi C, Turreni F, Gasparini G, Accardi F, Raciti G, Raviele A. Prevention of Syncope Through Permanent Cardiac Pacing in Patients With Bifascicular Block and Syncope of Unexplained Origin. Circ Arrhythm Electrophysiol 2013; 6:101-7. [DOI: 10.1161/circep.112.975102] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Syncope in patients with bifascicular block (BFB) is a common event whose causes might be difficult to assess.
Methods and Results—
Prevention of syncope through permanent cardiac pacing in patients with bifascicular block (PRESS) is a multicenter, prospective, randomized, single-blinded study designed to demonstrate a reduction in symptomatic events in patients with bifascicular block and syncope of undetermined origin implanted with permanent pacemaker. Device programming mode (NASPE/BPEG code) at DDD with a lower rate of 60 ppm is compared with backup pacing at DDI with a lower rate of 30 ppm. The end point consisted of (1) syncope, (2) symptomatic presyncopal episodes associated with a device intervention (ventricular pacing), and (3) symptomatic episodes associated with intermittent or permanent atrioventricular block (any degree). One hundred one patients were enrolled and randomized. Primary end point events at 2 years were observed in 23 patients, with a significant lower incidence in the study group (hazard ratio, 0.32; 95% confidence interval [CI], 0.10–0.96;
P
=0.042). Reduction of any symptoms, associated or not with device intervention, was superior in DDD60 compared with DDI30 (hazard ratio, 0.4; 95% confidence interval, 0.25–0.78;
P
=0.0053). Fourteen patients developed other rhythm diseases and met class I indication for pacing. The annual incidence of rhythm disease development was 7.4%.
Conclusions—
In patients with bifascicular block and syncope of undetermined origin, the use of a dual chamber pacemaker programmed to DDD60 led to a significant reduction of syncope or symptomatic events associated with a cardioinhibitory origin, compared with DDI30 programming. Symptoms associated with a new onset of rhythm disease were found in 15% of the population at 2 years.
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Affiliation(s)
- Massimo Santini
- From the Azienda Ospedaliera S. Filippo Neri, Roma, Italy (M.S., R.R.); Ospedale Sandro Pertini, Roma, Italy (A.C., M.L.L., F.T.); Ospedale Umberto I, Mestre, Italy (F.G., G.Gas., A.R.); Azienda Ospedaliera Ospedale Maggiore, Crema, Italy (G.I., C.P.); Azienda Ospedaliera Villa Scassi, Sampierdarena, Italy (G.Gag.); Policlinico Casilino, Roma, Italy (L.Ca.); Ospedale Civile S. Camillo De Lellis, Rieti, Italy (S.O.); Azienda Ospedaliera San Sebastiano, Caserta, Italy (M.V.); Ospedale Santa Maria
| | - Antonio Castro
- From the Azienda Ospedaliera S. Filippo Neri, Roma, Italy (M.S., R.R.); Ospedale Sandro Pertini, Roma, Italy (A.C., M.L.L., F.T.); Ospedale Umberto I, Mestre, Italy (F.G., G.Gas., A.R.); Azienda Ospedaliera Ospedale Maggiore, Crema, Italy (G.I., C.P.); Azienda Ospedaliera Villa Scassi, Sampierdarena, Italy (G.Gag.); Policlinico Casilino, Roma, Italy (L.Ca.); Ospedale Civile S. Camillo De Lellis, Rieti, Italy (S.O.); Azienda Ospedaliera San Sebastiano, Caserta, Italy (M.V.); Ospedale Santa Maria
| | - Franco Giada
- From the Azienda Ospedaliera S. Filippo Neri, Roma, Italy (M.S., R.R.); Ospedale Sandro Pertini, Roma, Italy (A.C., M.L.L., F.T.); Ospedale Umberto I, Mestre, Italy (F.G., G.Gas., A.R.); Azienda Ospedaliera Ospedale Maggiore, Crema, Italy (G.I., C.P.); Azienda Ospedaliera Villa Scassi, Sampierdarena, Italy (G.Gag.); Policlinico Casilino, Roma, Italy (L.Ca.); Ospedale Civile S. Camillo De Lellis, Rieti, Italy (S.O.); Azienda Ospedaliera San Sebastiano, Caserta, Italy (M.V.); Ospedale Santa Maria
| | - Renato Ricci
- From the Azienda Ospedaliera S. Filippo Neri, Roma, Italy (M.S., R.R.); Ospedale Sandro Pertini, Roma, Italy (A.C., M.L.L., F.T.); Ospedale Umberto I, Mestre, Italy (F.G., G.Gas., A.R.); Azienda Ospedaliera Ospedale Maggiore, Crema, Italy (G.I., C.P.); Azienda Ospedaliera Villa Scassi, Sampierdarena, Italy (G.Gag.); Policlinico Casilino, Roma, Italy (L.Ca.); Ospedale Civile S. Camillo De Lellis, Rieti, Italy (S.O.); Azienda Ospedaliera San Sebastiano, Caserta, Italy (M.V.); Ospedale Santa Maria
| | - Giuseppe Inama
- From the Azienda Ospedaliera S. Filippo Neri, Roma, Italy (M.S., R.R.); Ospedale Sandro Pertini, Roma, Italy (A.C., M.L.L., F.T.); Ospedale Umberto I, Mestre, Italy (F.G., G.Gas., A.R.); Azienda Ospedaliera Ospedale Maggiore, Crema, Italy (G.I., C.P.); Azienda Ospedaliera Villa Scassi, Sampierdarena, Italy (G.Gag.); Policlinico Casilino, Roma, Italy (L.Ca.); Ospedale Civile S. Camillo De Lellis, Rieti, Italy (S.O.); Azienda Ospedaliera San Sebastiano, Caserta, Italy (M.V.); Ospedale Santa Maria
| | - Germano Gaggioli
- From the Azienda Ospedaliera S. Filippo Neri, Roma, Italy (M.S., R.R.); Ospedale Sandro Pertini, Roma, Italy (A.C., M.L.L., F.T.); Ospedale Umberto I, Mestre, Italy (F.G., G.Gas., A.R.); Azienda Ospedaliera Ospedale Maggiore, Crema, Italy (G.I., C.P.); Azienda Ospedaliera Villa Scassi, Sampierdarena, Italy (G.Gag.); Policlinico Casilino, Roma, Italy (L.Ca.); Ospedale Civile S. Camillo De Lellis, Rieti, Italy (S.O.); Azienda Ospedaliera San Sebastiano, Caserta, Italy (M.V.); Ospedale Santa Maria
| | - Leonardo Calò
- From the Azienda Ospedaliera S. Filippo Neri, Roma, Italy (M.S., R.R.); Ospedale Sandro Pertini, Roma, Italy (A.C., M.L.L., F.T.); Ospedale Umberto I, Mestre, Italy (F.G., G.Gas., A.R.); Azienda Ospedaliera Ospedale Maggiore, Crema, Italy (G.I., C.P.); Azienda Ospedaliera Villa Scassi, Sampierdarena, Italy (G.Gag.); Policlinico Casilino, Roma, Italy (L.Ca.); Ospedale Civile S. Camillo De Lellis, Rieti, Italy (S.O.); Azienda Ospedaliera San Sebastiano, Caserta, Italy (M.V.); Ospedale Santa Maria
| | - Serafino Orazi
- From the Azienda Ospedaliera S. Filippo Neri, Roma, Italy (M.S., R.R.); Ospedale Sandro Pertini, Roma, Italy (A.C., M.L.L., F.T.); Ospedale Umberto I, Mestre, Italy (F.G., G.Gas., A.R.); Azienda Ospedaliera Ospedale Maggiore, Crema, Italy (G.I., C.P.); Azienda Ospedaliera Villa Scassi, Sampierdarena, Italy (G.Gag.); Policlinico Casilino, Roma, Italy (L.Ca.); Ospedale Civile S. Camillo De Lellis, Rieti, Italy (S.O.); Azienda Ospedaliera San Sebastiano, Caserta, Italy (M.V.); Ospedale Santa Maria
| | - Miguel Viscusi
- From the Azienda Ospedaliera S. Filippo Neri, Roma, Italy (M.S., R.R.); Ospedale Sandro Pertini, Roma, Italy (A.C., M.L.L., F.T.); Ospedale Umberto I, Mestre, Italy (F.G., G.Gas., A.R.); Azienda Ospedaliera Ospedale Maggiore, Crema, Italy (G.I., C.P.); Azienda Ospedaliera Villa Scassi, Sampierdarena, Italy (G.Gag.); Policlinico Casilino, Roma, Italy (L.Ca.); Ospedale Civile S. Camillo De Lellis, Rieti, Italy (S.O.); Azienda Ospedaliera San Sebastiano, Caserta, Italy (M.V.); Ospedale Santa Maria
| | - Leandro Chiodi
- From the Azienda Ospedaliera S. Filippo Neri, Roma, Italy (M.S., R.R.); Ospedale Sandro Pertini, Roma, Italy (A.C., M.L.L., F.T.); Ospedale Umberto I, Mestre, Italy (F.G., G.Gas., A.R.); Azienda Ospedaliera Ospedale Maggiore, Crema, Italy (G.I., C.P.); Azienda Ospedaliera Villa Scassi, Sampierdarena, Italy (G.Gag.); Policlinico Casilino, Roma, Italy (L.Ca.); Ospedale Civile S. Camillo De Lellis, Rieti, Italy (S.O.); Azienda Ospedaliera San Sebastiano, Caserta, Italy (M.V.); Ospedale Santa Maria
| | - Angelo Bartoletti
- From the Azienda Ospedaliera S. Filippo Neri, Roma, Italy (M.S., R.R.); Ospedale Sandro Pertini, Roma, Italy (A.C., M.L.L., F.T.); Ospedale Umberto I, Mestre, Italy (F.G., G.Gas., A.R.); Azienda Ospedaliera Ospedale Maggiore, Crema, Italy (G.I., C.P.); Azienda Ospedaliera Villa Scassi, Sampierdarena, Italy (G.Gag.); Policlinico Casilino, Roma, Italy (L.Ca.); Ospedale Civile S. Camillo De Lellis, Rieti, Italy (S.O.); Azienda Ospedaliera San Sebastiano, Caserta, Italy (M.V.); Ospedale Santa Maria
| | - Giovanni Foglia-Manzillo
- From the Azienda Ospedaliera S. Filippo Neri, Roma, Italy (M.S., R.R.); Ospedale Sandro Pertini, Roma, Italy (A.C., M.L.L., F.T.); Ospedale Umberto I, Mestre, Italy (F.G., G.Gas., A.R.); Azienda Ospedaliera Ospedale Maggiore, Crema, Italy (G.I., C.P.); Azienda Ospedaliera Villa Scassi, Sampierdarena, Italy (G.Gag.); Policlinico Casilino, Roma, Italy (L.Ca.); Ospedale Civile S. Camillo De Lellis, Rieti, Italy (S.O.); Azienda Ospedaliera San Sebastiano, Caserta, Italy (M.V.); Ospedale Santa Maria
| | - Fabrizio Ammirati
- From the Azienda Ospedaliera S. Filippo Neri, Roma, Italy (M.S., R.R.); Ospedale Sandro Pertini, Roma, Italy (A.C., M.L.L., F.T.); Ospedale Umberto I, Mestre, Italy (F.G., G.Gas., A.R.); Azienda Ospedaliera Ospedale Maggiore, Crema, Italy (G.I., C.P.); Azienda Ospedaliera Villa Scassi, Sampierdarena, Italy (G.Gag.); Policlinico Casilino, Roma, Italy (L.Ca.); Ospedale Civile S. Camillo De Lellis, Rieti, Italy (S.O.); Azienda Ospedaliera San Sebastiano, Caserta, Italy (M.V.); Ospedale Santa Maria
| | - Maria L. Loricchio
- From the Azienda Ospedaliera S. Filippo Neri, Roma, Italy (M.S., R.R.); Ospedale Sandro Pertini, Roma, Italy (A.C., M.L.L., F.T.); Ospedale Umberto I, Mestre, Italy (F.G., G.Gas., A.R.); Azienda Ospedaliera Ospedale Maggiore, Crema, Italy (G.I., C.P.); Azienda Ospedaliera Villa Scassi, Sampierdarena, Italy (G.Gag.); Policlinico Casilino, Roma, Italy (L.Ca.); Ospedale Civile S. Camillo De Lellis, Rieti, Italy (S.O.); Azienda Ospedaliera San Sebastiano, Caserta, Italy (M.V.); Ospedale Santa Maria
| | - Claudio Pedrinazzi
- From the Azienda Ospedaliera S. Filippo Neri, Roma, Italy (M.S., R.R.); Ospedale Sandro Pertini, Roma, Italy (A.C., M.L.L., F.T.); Ospedale Umberto I, Mestre, Italy (F.G., G.Gas., A.R.); Azienda Ospedaliera Ospedale Maggiore, Crema, Italy (G.I., C.P.); Azienda Ospedaliera Villa Scassi, Sampierdarena, Italy (G.Gag.); Policlinico Casilino, Roma, Italy (L.Ca.); Ospedale Civile S. Camillo De Lellis, Rieti, Italy (S.O.); Azienda Ospedaliera San Sebastiano, Caserta, Italy (M.V.); Ospedale Santa Maria
| | - Federico Turreni
- From the Azienda Ospedaliera S. Filippo Neri, Roma, Italy (M.S., R.R.); Ospedale Sandro Pertini, Roma, Italy (A.C., M.L.L., F.T.); Ospedale Umberto I, Mestre, Italy (F.G., G.Gas., A.R.); Azienda Ospedaliera Ospedale Maggiore, Crema, Italy (G.I., C.P.); Azienda Ospedaliera Villa Scassi, Sampierdarena, Italy (G.Gag.); Policlinico Casilino, Roma, Italy (L.Ca.); Ospedale Civile S. Camillo De Lellis, Rieti, Italy (S.O.); Azienda Ospedaliera San Sebastiano, Caserta, Italy (M.V.); Ospedale Santa Maria
| | - Gianni Gasparini
- From the Azienda Ospedaliera S. Filippo Neri, Roma, Italy (M.S., R.R.); Ospedale Sandro Pertini, Roma, Italy (A.C., M.L.L., F.T.); Ospedale Umberto I, Mestre, Italy (F.G., G.Gas., A.R.); Azienda Ospedaliera Ospedale Maggiore, Crema, Italy (G.I., C.P.); Azienda Ospedaliera Villa Scassi, Sampierdarena, Italy (G.Gag.); Policlinico Casilino, Roma, Italy (L.Ca.); Ospedale Civile S. Camillo De Lellis, Rieti, Italy (S.O.); Azienda Ospedaliera San Sebastiano, Caserta, Italy (M.V.); Ospedale Santa Maria
| | - Francesco Accardi
- From the Azienda Ospedaliera S. Filippo Neri, Roma, Italy (M.S., R.R.); Ospedale Sandro Pertini, Roma, Italy (A.C., M.L.L., F.T.); Ospedale Umberto I, Mestre, Italy (F.G., G.Gas., A.R.); Azienda Ospedaliera Ospedale Maggiore, Crema, Italy (G.I., C.P.); Azienda Ospedaliera Villa Scassi, Sampierdarena, Italy (G.Gag.); Policlinico Casilino, Roma, Italy (L.Ca.); Ospedale Civile S. Camillo De Lellis, Rieti, Italy (S.O.); Azienda Ospedaliera San Sebastiano, Caserta, Italy (M.V.); Ospedale Santa Maria
| | - Giovanni Raciti
- From the Azienda Ospedaliera S. Filippo Neri, Roma, Italy (M.S., R.R.); Ospedale Sandro Pertini, Roma, Italy (A.C., M.L.L., F.T.); Ospedale Umberto I, Mestre, Italy (F.G., G.Gas., A.R.); Azienda Ospedaliera Ospedale Maggiore, Crema, Italy (G.I., C.P.); Azienda Ospedaliera Villa Scassi, Sampierdarena, Italy (G.Gag.); Policlinico Casilino, Roma, Italy (L.Ca.); Ospedale Civile S. Camillo De Lellis, Rieti, Italy (S.O.); Azienda Ospedaliera San Sebastiano, Caserta, Italy (M.V.); Ospedale Santa Maria
| | - Antonio Raviele
- From the Azienda Ospedaliera S. Filippo Neri, Roma, Italy (M.S., R.R.); Ospedale Sandro Pertini, Roma, Italy (A.C., M.L.L., F.T.); Ospedale Umberto I, Mestre, Italy (F.G., G.Gas., A.R.); Azienda Ospedaliera Ospedale Maggiore, Crema, Italy (G.I., C.P.); Azienda Ospedaliera Villa Scassi, Sampierdarena, Italy (G.Gag.); Policlinico Casilino, Roma, Italy (L.Ca.); Ospedale Civile S. Camillo De Lellis, Rieti, Italy (S.O.); Azienda Ospedaliera San Sebastiano, Caserta, Italy (M.V.); Ospedale Santa Maria
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Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO. 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation 2012; 127:e283-352. [PMID: 23255456 DOI: 10.1161/cir.0b013e318276ce9b] [Citation(s) in RCA: 374] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO, Tracy CM, Epstein AE, Darbar D, DiMarco JP, Dunbar SB, Estes NAM, Ferguson TB, Hammill SC, Karasik PE, Link MS, Marine JE, Schoenfeld MH, Shanker AJ, Silka MJ, Stevenson LW, Stevenson WG, Varosy PD. 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2012; 61:e6-75. [PMID: 23265327 DOI: 10.1016/j.jacc.2012.11.007] [Citation(s) in RCA: 559] [Impact Index Per Article: 46.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Moya A, García-Civera R, Croci F, Menozzi C, Brugada J, Ammirati F, Del Rosso A, Bellver-Navarro A, Garcia-Sacristán J, Bortnik M, Mont L, Ruiz-Granell R, Navarro X. Diagnosis, management, and outcomes of patients with syncope and bundle branch block. Eur Heart J 2011; 32:1535-41. [PMID: 21444367 PMCID: PMC3114095 DOI: 10.1093/eurheartj/ehr071] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Aims Although patients with syncope and bundle branch block (BBB) are at high risk of developing atrio-ventricular block, syncope may be due to other aetiologies. We performed a prospective, observational study of the clinical outcomes of patients with syncope and BBB following a systematic diagnostic approach. Methods and results Patients with ≥1 syncope in the last 6 months, with QRS duration ≥120 ms, were prospectively studied following a three-phase diagnostic strategy: Phase I, initial evaluation; Phase II, electrophysiological study (EPS); and Phase III, insertion of an implantable loop recorder (ILR). Overall, 323 patients (left ventricular ejection fraction 56 ± 12%) were studied. The aetiological diagnosis was established in 267 (82.7%) patients (102 at initial evaluation, 113 upon EPS, and 52 upon ILR) with the following aetiologies: bradyarrhythmia (202), carotid sinus syndrome (20), ventricular tachycardia (18), neurally mediated (9), orthostatic hypotension (4), drug-induced (3), secondary to cardiopulmonary disease (2), supraventricular tachycardia (1), bradycardia–tachycardia (1), and non-arrhythmic (7). A pacemaker was implanted in 220 (68.1%), an implantable cardioverter defibrillator in 19 (5.8%), and radiofrequency catheter ablation was performed in 3 patients. Twenty patients (6%) had died at an average follow-up of 19.2 ± 8.2 months. Conclusion In patients with syncope, BBB, and mean left ventricular ejection fraction of 56 ± 12%, a systematic diagnostic approach achieves a high rate of aetiological diagnosis and allows to select specific treatment.
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Affiliation(s)
- Angel Moya
- Hospital General Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, Passeig Vall d'Hebron 119-129, Barcelona, Spain.
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Nuevos predictores de evolución a bloqueo auriculoventricular en pacientes con bloqueo bifascicular. Rev Esp Cardiol 2010. [DOI: 10.1016/s0300-8932(10)70060-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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21
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Marti-Almor J, Cladellas M, Bazan V, Altaba C, Guijo M, Delclos J, Bruguera-Cortada J. Long-term mortality predictors in patients with chronic bifascicular block. Europace 2009; 11:1201-7. [DOI: 10.1093/europace/eup181] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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22
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Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO, Smith SC, Jacobs AK, Adams CD, Anderson JL, Buller CE, Creager MA, Ettinger SM, Faxon DP, Halperin JL, Hiratzka LF, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura RA, Ornato JP, Page RL, Riegel B, Tarkington LG, Yancy CW. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. J Am Coll Cardiol 2008; 51:e1-62. [PMID: 18498951 DOI: 10.1016/j.jacc.2008.02.032] [Citation(s) in RCA: 1090] [Impact Index Per Article: 68.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Epstein AE, DiMarco JP, Ellenbogen KA, Estes NM, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: Executive Summary. Circulation 2008. [DOI: 10.1161/circualtionaha.108.189741] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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ACC/AHA/HRS 2008 Guidelines for device-based therapy of cardiac rhythm abnormalities. Heart Rhythm 2008; 5:e1-62. [PMID: 18534360 DOI: 10.1016/j.hrthm.2008.04.014] [Citation(s) in RCA: 196] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Indexed: 01/27/2023]
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25
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Epstein AE, Dimarco JP, Ellenbogen KA, Estes NAM, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO. ACC/AHA/HRS 2008 guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: executive summary. Heart Rhythm 2008; 5:934-55. [PMID: 18534377 DOI: 10.1016/j.hrthm.2008.04.015] [Citation(s) in RCA: 267] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Indexed: 11/16/2022]
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26
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Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO, Smith SC, Jacobs AK, Adams CD, Anderson JL, Buller CE, Creager MA, Ettinger SM, Faxon DP, Halperin JL, Hiratzka LF, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura RA, Ornato JP, Page RL, Riegel B, Tarkington LG, Yancy CW. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Circulation 2008; 117:e350-408. [PMID: 18483207 DOI: 10.1161/circualtionaha.108.189742] [Citation(s) in RCA: 935] [Impact Index Per Article: 58.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Falls in older people can be caused by underlying cardiovascular disorders, either because of balance instability in persons with background gait and balance disorders, or because of amnesia for loss of consciousness during unwitnessed syncope. Pertinent investigations include a detailed history, 12-lead electrocardiography, lying and standing blood pressure, carotid sinus massage (CSM), head-up tilt, cardiac electrophysiological tests, and ambulatory blood pressure and heart rate monitoring, which includes external and internal cardiac monitoring. The presence of structural heart disease predicts an underlying cardiac cause. Conversely, the absence of either indicates that neurally mediated etiology is likely. CSM and tilt-table testing should be considered in patients with unexplained and recurrent falls. Holter monitoring over 24 hours has a low diagnostic yield. Early use of an implantable loop recorder may be more cost-effective. A dedicated investigation unit increases the likelihood of achieving positive diagnoses and significantly reduces hospital stay and health expenditure.
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Affiliation(s)
- Maw Pin Tan
- Falls and Syncope Service, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
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29
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Francia P, Balla C, Paneni F, Volpe M. Left bundle-branch block--pathophysiology, prognosis, and clinical management. Clin Cardiol 2007; 30:110-5. [PMID: 17385703 PMCID: PMC6653265 DOI: 10.1002/clc.20034] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Given its broad use as a screening tool, the electrocardiogram (ECG) has largely become one of the most common diagnostic tests performed in routine clinical practice. As a result, the finding of left bundle-branch block (LBBB) in the absence of a well-defined clinical setting has become relatively frequent and raises questions and often concerns. While in the absence of clinically detectable heart disease LBBB does not necessarily imply poor outcomes, physicians should be aware of the role of LBBB in stratifying risk of cardiovascular events and death in subjects with both ischemic and nonischemic heart disease. This paper reviews historical landmarks, pathophysiologic features, prognostic implications, and clinical management of LBBB in apparently healthy subjects and those with heart disease.
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Affiliation(s)
- Pietro Francia
- Chair and Division of Cardiology, II Faculty of Medicine, Sant'Andrea Hospital, University “La Sapienza,” Rome, Italy
| | - Cristina Balla
- Chair and Division of Cardiology, II Faculty of Medicine, Sant'Andrea Hospital, University “La Sapienza,” Rome, Italy
| | - Francesco Paneni
- Chair and Division of Cardiology, II Faculty of Medicine, Sant'Andrea Hospital, University “La Sapienza,” Rome, Italy
| | - Massimo Volpe
- Chair and Division of Cardiology, II Faculty of Medicine, Sant'Andrea Hospital, University “La Sapienza,” Rome, Italy
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Bogale N, Orn S, James M, McCarroll K, de Luna AB, Dickstein K. Usefulness of either or both left and right bundle branch block at baseline or during follow-up for predicting death in patients following acute myocardial infarction. Am J Cardiol 2007; 99:647-50. [PMID: 17317365 DOI: 10.1016/j.amjcard.2006.09.113] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2006] [Revised: 09/28/2006] [Accepted: 09/28/2006] [Indexed: 10/23/2022]
Abstract
The presence or onset of bundle branch block (BBB) is associated with increased mortality in patients after acute myocardial infarction (AMI). The risk increases with age. We assessed the prognostic power of BBB patterns for predicting clinical outcomes in patients after high-risk AMI. In the OPTIMAAL trial, the effects of losartan versus captopril were compared in 5,477 patients with heart failure and/or evidence of left ventricular dysfunction after MI. The association between clinical outcomes and the presence of left or right BBB at randomization (median 3 days after AMI) or occurring during follow-up (mean 2.7 years) was assessed using Cox regression models. At randomization, 8% of patients (n = 438) showed BBB patterns; 3.7% (n = 203) showed left BBB and 4.3% (n = 235) showed right BBB patterns. In patients with left BBB, there was an increased risk of all-cause death and cardiovascular death. In patients with right BBB, there was increased risk of sudden cardiac death/resuscitated cardiac arrest. During follow-up, another 4.9% (n = 272) developed BBB patterns; 2.8% (n = 153) developed left BBB and 2.17% (n = 119) developed right BBB. Left BBB was associated with increased risk for all-cause death, cardiovascular death, and sudden cardiac death/resuscitated cardiac arrest, whereas right BBB was related to increased risk of sudden cardiac death/resuscitated cardiac arrest. In conclusion, our results confirm and quantify previous observations showing substantially increased mortality in patients with BBB patterns at baseline or occurring soon after AMI.
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Affiliation(s)
- Nigussie Bogale
- Stavanger University Hospital, Department of Cardiology, Stavanger, Norway.
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31
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Tabrizi F, Rosenqvist M, Bergfeldt L, Englund A. Long-term prognosis in patients with bifascicular block--the predictive value of noninvasive and invasive assessment. J Intern Med 2006; 260:31-8. [PMID: 16789976 DOI: 10.1111/j.1365-2796.2006.01651.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Patients with bifascicular block (BFB) have a high mortality rate. The purpose of the present study was to identify high-risk patients in a BFB population by performing an extensive cardiac evaluation including noninvasive and invasive tests. DESIGN Population-based study. SUBJECTS A total of 100 patients with BFB, of whom 41 had a history of unexplained syncope, were prospectively studied. The mean age was 68 +/- 12. All patients were investigated with Holter-monitoring, an exercise test, an echocardiography, and an invasive electrophysiological study. The severity of congestive heart failure (CHF) was assessed by New York Heart Association (NYHA) classification. Patients in NYHA class IV were excluded. INTERVENTIONS Patients with syncope were recommended prophylactic pacemaker treatment, which was accepted by 31 patients (76%). Main outcome measures. All-cause mortality and sudden cardiac death (SCD). RESULTS During a median follow-up of 84 months, 33 patients died, of whom 14 in SCD. In a univariate analysis, high age, a previous myocardial infarction, and CHF were associated with a significantly increased risk of all-cause mortality and SCD. In a Cox multiple regression analysis, CHF was the only independent predictor of all-cause mortality and SCD (P < 0.01). CONCLUSION Patients with BFB have a poor long-term prognosis. The predictive value of noninvasive and invasive investigations is limited. The only independent predictor of all-cause mortality and SCD in this population was the presence of CHF.
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Affiliation(s)
- F Tabrizi
- Department of Cardiology, Karolinska Institute, South Hospital, Stockholm, Sweden.
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32
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Seidl K, Schuchert A, Tebbenjohanns J, Hartung W. [Commentary on the guidelines the diagnosis and the therapy of syncope--the European Society of Cardiology 2001 and the update 2004]. ACTA ACUST UNITED AC 2005; 94:592-612. [PMID: 16142520 DOI: 10.1007/s00392-005-0230-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- K Seidl
- Herzzentrum Ludwigshafen, Medizinische Klinik B (Kardiologie, Pneumologie, Angiologie), Bremserstr. 79, 67063 Ludwigshafen, Germany.
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Kesek M, Jernberg T, Lindahl B, Xue J, Englund A. Principal Component Analysis of the T Wave in Patients with Chest Pain and Conduction Disturbances. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2004; 27:1378-87. [PMID: 15511247 DOI: 10.1111/j.1540-8159.2004.00642.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There is a need for markers reflecting the increased risk in patients with conduction disturbances. Conduction disturbances presumably cause inhomogeneous repolarization that may create an arrhythmogenic substrate. In patients with normal conduction, parameters derived from principal components analysis (PCA) of the T wave contain prognostic information. The nondipolar PCA components are assumed to reflect repolarization inhomogeneity. This study examined the PCA parameters in relation to conduction disturbances. PCA was performed on continuously recorded 12-lead ECGs in 800 patients with chest pain and nondiagnostic ECG on admission. The patients with conduction disturbance on admission were classified into separate groups and related to comparison groups without conduction disturbance recruited from the same series. For each patient, the dipolar and nondipolar components were quantified by medians of the ratio of the two largest eigenvalues (S2/S1 Median), the residue that summarizes the eigenvalues S4-S8 (TWRabsMedian) and the ratio of this residue to the total power of the T wave (TWRrelMedian). The parameters were assessed with respect to common clinical and ECG parameters, discharge diagnosis, and total mortality during a 35-month follow-up. TWRabsMedian increased with increasing conduction disturbance. In 135 patients with conduction disturbances, ROC curves for TWRabsMedian as indicator of mortality exhibited areas under a curve of 0.66, 0.65, and 0.56 at 6-month, 24-month, and 35-month follow-up. Conduction disturbances were associated with increased nondipolar PCA component and, thus, with increased repolarization inhomogeneity. The nondipolar PCA component contained a moderate amount of prognostic information not present in a simple ECG diagnosis of a conduction disturbance.
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Affiliation(s)
- Milos Kesek
- Department of Cardiology, Norrland University Hospital, Umeå, Sweden.
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Jeong JH, Kim JH, Park YH, Han DC, Hwang KW, Lee DW, Oh JH, Song SG, Kim JS, Chun KJ, Hong TJ, Shin YW. Incidence of and risk factors for bundle branch block in adults older than 40 years. Korean J Intern Med 2004; 19:171-8. [PMID: 15481609 PMCID: PMC4531556 DOI: 10.3904/kjim.2004.19.3.171] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND In the general population, the incidence of bundle branch block (BBB) is relatively low, and its effects on long-term prognosis have not been established. Previous studies on the incidence and correlation of BBB to clinical factors have produced conflicting results. However, the incidence of BBB was strongly related to age. This study aimed to describe the incidence of and risk factors for BBB in Korea. METHODS In this study, 14,540 adults (male 6,573/female 7,967) > or = 40 years old received screening tests for general health between April and December 2000. Participants answered questionnaires and underwent examinations, which included blood pressure, electrocardiogram (ECG), total cholesterol and fasting glucose. The data analysis was performed using SPSS 10.0 for windows. RESULTS The incidences of complete right bundle branch block (CRBBB) were 1.5 and 2.9% in people older than 40 and 65 years, respectively. Approximately 38.0% of individuals with CRBBB were older than 65 years. The incidence of CRBBB was higher in men than women at all age groups was highest in those aged 75-79 years. Males, advancing age (> or = 65 years), hypertension and diabetes mellitus (DM) were associated with an increased risk of CRBBB. The incidences of complete left bundle branch block (LBBB) and bifascicular bundle branch block (BBBB) were 0.1 and 0.08% and 0.3 and 0.2% in those older than 40 and 65 years, respectively. Approximately 71.4 and 58.3% of individuals with LBBB and BBBB, respectively, were older than 65 years. Advancing age and cardiac disease were associated with an increased risk of LBBB. Advancing age was associated with an increased risk of BBBB. The most potent risk factor for BBB in this study was advancing age. CONCLUSION The incidences of BBB were 1.7 and 3.4% in those older than 40 and 65 years respectively. Bundle branch block correlates strongly with age, and is common in the older ages groups. These findings support the theory that bundle branch block is a marker of slowly progressing degenerative diseases.
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Affiliation(s)
| | - June Hong Kim
- Correspondence to: June Hong Kim, M.D., Department of Internal Medicine, Pusan National University College of Medicine, 1 Ga-10 Ami-dong, Seo-gu, Busan, 602-739, Korea, Tel: 82-51-240-7866, Fax: 82-51-240-7796, E-mail:
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Matsushita T, Chun S, Liem LB, Friday KJ, Sung RJ. Significance of inducible ventricular flutter/fibrillation in risk stratification in patients with coronary artery disease. Int J Cardiol 2004; 94:67-71. [PMID: 14996477 DOI: 10.1016/j.ijcard.2003.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2003] [Accepted: 04/12/2003] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although inducible ventricular fibrillation (VF) has been used as an indication for prophylactic implantation of cardioverter-defibrillators (ICDs) in patients with coronary artery disease (CAD), the significance of inducible VF remains controversial. METHODS Among 364 CAD patients who underwent electrophysiologic (EP) study for risk stratification, 23 patients, 12 without any history of VF or cardiac arrest (group A) and 11 with previously documented VF or cardiac arrest (group B), exhibited inducible ventricular flutter (VFL) or VF and subsequently underwent ICD implantation. Additionally, 11 CAD patients without previous VF or cardiac arrest, who had no inducible ventricular tachyarrhythmias but received an ICD, were included for comparison (group C). RESULTS During 2 years of follow-up, 1 (8%), 5 (45%), and 1 (9%) patients had appropriate ICD shocks in groups A, B, and C, respectively. The survival free from appropriate ICD shocks was significantly lower in group B compared to groups A and C (p<0.05). There were no significant differences in age, sex, ejection fraction (EF), or induction protocol between groups A and B or between groups A and C. CONCLUSIONS In CAD patients with inducible VFL/VF, patients without any history of VF or cardiac arrest had significantly lower incidence of appropriate ICD shocks when compared to those with such clinical events. Conversely, in CAD patients without any history of VF or cardiac arrest, incidence of appropriate ICD shocks was similar regardless of inducible VFL/VF. Inducible VFL/VF is therefore not useful as an indication for prophylactic ICD implantation in this patient population.
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Affiliation(s)
- Takehiko Matsushita
- Cardiac Electrophysiology and Arrhythmia Service, Stanford University Medical Center, 300 Pasteur Drive Room H2146, Stanford, CA 94305-5233, USA.
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Horwich T, Lee SJ, Saxon L. Usefulness of QRS prolongation in predicting risk of inducible monomorphic ventricular tachycardiain patients referred forelectrophysiologic studies. Am J Cardiol 2003; 92:804-9. [PMID: 14516880 DOI: 10.1016/s0002-9149(03)00887-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
QRS prolongation on surface electrocardiography has been identified as a marker for increased cardiac mortality. A potential mechanism for increased mortality is ventricular tachycardia (VT). This study aimed to evaluate the relation between bundle branch block and sustained monomorphic VT inducibility in patients referred for electrophysiologic studies. We analyzed a cohort of 777 patients (age 63 +/- 18 years, 67% men, left ventricular [LV] ejection fraction [EF] 45% +/- 16, prior myocardial infarction 41%) referred for electrophysiologic studies between 1994 and 2001 who underwent programmed stimulation for VT. Forty-five percent of patients were referred for syncope or a history of VT and/or ventricular fibrillation. Thirty-one percent of patients had prolonged QRS duration (> or =120 ms). Patients with prolonged QRS duration were older, had lower LVEFs, and were more likely to have a history of myocardial infarction. Prolonged QRS was a significant predictor of sustained monomorphic VT inducibility (p <0.0001). On multivariate analysis correcting for age, sex, LVEF, history of myocardial infarction, medications, and QRS conduction delay proved to be independently associated with sustained monomorphic VT inducibility (relative risk 3.290, 95% confidence interval 2.185 to 4.953 for prolonged vs normal QRS duration). Thus, a prolonged QRS duration on surface electrocardiography is a strong, independent predictor of inducible sustained monomorphic VT. Conduction delay may be an important risk factor, providing a substrate for the development of reentrant monomorphic VT, and furthermore suggests a potential mechanism for the increased mortality observed in patients with prolonged QRS.
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Affiliation(s)
- Tamara Horwich
- Division of Cardiology, University of California-San Francisco, San Francisco, California 90093, USA
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Gregoratos G, Abrams J, Epstein AE, Freedman RA, Hayes DL, Hlatky MA, Kerber RE, Naccarelli GV, Schoenfeld MH, Silka MJ, Winters SL. ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/NASPE Committee to Update the 1998 Pacemaker Guidelines). J Am Coll Cardiol 2002; 40:1703-19. [PMID: 12427427 DOI: 10.1016/s0735-1097(02)02528-7] [Citation(s) in RCA: 270] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Gabriel Gregoratos
- Resource Center, American College of Cardiology Foundation, 9111 Old Georgetown Road, Bethesda, MD 20814-1699, USA
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Gregoratos G, Abrams J, Epstein AE, Freedman RA, Hayes DL, Hlatky MA, Kerber RE, Naccarelli GV, Schoenfeld MH, Silka MJ, Winters SL, Gibbons RJ, Antman EM, Alpert JS, Gregoratos G, Hiratzka LF, Faxon DP, Jacobs AK, Fuster V, Smith SC. ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/NASPE Committee to Update the 1998 Pacemaker Guidelines). Circulation 2002; 106:2145-61. [PMID: 12379588 DOI: 10.1161/01.cir.0000035996.46455.09] [Citation(s) in RCA: 534] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
There is a high prevalence of cardiovascular disorders among elderly patients with recurrent falls or syncope, and cardiovascular causes are implicated in a significant proportion of three cases. Common cardiovascular causes of falls and syncope include carotid sinus syndrome, vasovagal episodes, sick sinus syndrome, and atrioventricular block. A comprehensive history and physical examination supplemented by electrocardiographic monitoring, carotid sinus massage, and tilt-table testing in appropriately selected patients form the basis of the diagnostic evaluation to exclude a significant cardiovascular disorder. Patients with documented symptomatic bradycardia often benefit from pacemaker implantation, as evidenced by a reduction in recurrent events and improved quality of life. Although dual-chamber pacemakers, particularly those with rate responsiveness, provide more physiologic pacing than single-chamber ventricular devices, the superiority of dual-chamber pacemakers in reducing major clinical events has not been demonstrated. The efficacy of an aggressive evaluation and patient-management strategy that includes pacemaker implantation for elderly patients with recurrent falls has been validated only by one prospective clinical trial; however, available data are compelling. For a variety of cardiovascular conditions, permanent pacemaker implantation has a demonstrated efficacy to prevent symptoms that arise from transient hypotension and decreased cerebral perfusion. The implication of these data is that many falls may be preventable through permanent pacemaker implantation in appropriately selected patients.
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Affiliation(s)
- Mitchell N Faddis
- Clinical Cardiac Electrophysiology Unit, Washington University School of Medicine, Cardiology, Box 8086, 660 South Euclid Avenue, St. Louis, MO 63110, USA.
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Saxon LA, De Marco T. Cardiac resynchronization: a cornerstone in the foundation of device therapy for heart failure. J Am Coll Cardiol 2001; 38:1971-3. [PMID: 11738302 DOI: 10.1016/s0735-1097(01)01638-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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41
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Brignole M, Menozzi C, Moya A, Garcia-Civera R, Mont L, Alvarez M, Errazquin F, Beiras J, Bottoni N, Donateo P. Mechanism of syncope in patients with bundle branch block and negative electrophysiological test. Circulation 2001; 104:2045-50. [PMID: 11673344 DOI: 10.1161/hc4201.097837] [Citation(s) in RCA: 178] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In patients with syncope and bundle branch block (BBB), syncope is suspected to be attributable to a paroxysmal atrioventricular (AV) block, but little is known of its mechanism when electrophysiological study is negative. METHODS AND RESULTS We applied an implantable loop recorder in 52 patients with BBB and negative conventional workup. During a follow-up of 3 to 15 months, syncope recurred in 22 patients (42%), the event being documented in 19 patients after a median of 48 days. The most frequent finding, recorded in 17 patients, was one or more prolonged asystolic pause mainly attributable to AV block; the remaining 2 patients had normal sinus rhythm or sinus tachycardia. The onset of the bradycardic episodes was always sudden but was sometimes preceded by ventricular premature beats. The median duration of the arrhythmic event was 47 seconds. An additional 3 patients developed nonsyncopal persistent III-degree AV block, and 2 patients had presyncope attributable to AV block with asystole. No patients suffered injury attributable to syncopal relapse. CONCLUSIONS In patients with BBB and negative electrophysiological study, most syncopal recurrences have a homogeneous mechanism that is characterized by prolonged asystolic pauses, mainly attributable to sudden-onset paroxysmal AV block.
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Affiliation(s)
- M Brignole
- Departments of Cardiology, Ospedali Riuniti, Lavagna, Italy.
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Pires LA, May LM, Ravi S, Parry JT, Lal VR, Nino CL. Comparison of event rates and survival in patients with unexplained syncope without documented ventricular tachyarrhythmias versus patients with documented sustained ventricular tachyarrhythmias both treated with implantable cardioverter-defibrillators. Am J Cardiol 2000; 85:725-8. [PMID: 12000047 DOI: 10.1016/s0002-9149(99)00848-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Patients with unexplained syncope and inducible ventricular tachyarrhythmias during electrophysiologic testing have an increased cardiac mortality rate. We compared event rates and survival of 178 patients with unexplained syncope and no documented ventricular arrhythmias (syncope group) versus 568 patients with documented sustained ventricular tachycardia (VT or fibrillation (VF) (VT/VF group) treated, as part of a lead (Ventritex TVL) investigation, with similar implantable cardioverter-defibrillators (ICDs) capable of extensive data storage. The 2 groups shared similar clinical characteristics. The mean follow-up was 11 months for the syncope group and 14 months for the VT/VF group. The mean time from device implantation to first appropriate therapy was similar in the 2 groups (109 +/- 140 vs 93 +/- 131 days, p = 0.40). Actuarial probability of appropriate ICD therapy was 49% and 55% at 1 and 2 years, respectively, in syncope group and 49% and 58% in VT/VF group (p = 0.57). Recurrent syncope was associated with ventricular tachyarrhythmias in 85% and 92% of the syncope group and VT/VF group, respectively (p = 0.54). At 2 years, actuarial survival was 91% in the syncope group and 93% in VT/VF group (p = 0.85). We conclude that patients treated with ICD with unexplained syncope and induced VT/VF have an equally high incidence of appropriate ICD therapy and low mortality compared with similar patients with documented VT/VF. These findings, plus the high association between recurrent syncope and ventricular arrhythmias, indicate that VT/VF are likely etiologies in selected patients with unexplained syncope and support ICD therapy in such cases.
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Affiliation(s)
- L A Pires
- St John Hospital and Medical Center and Wayne State University School of Medicine Detroit, Michigan 48236, USA.
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Andrews NP, Fogel RI, Pelargonio G, Evans JJ, Prystowsky EN. Implantable defibrillator event rates in patients with unexplained syncope and inducible sustained ventricular tachyarrhythmias: a comparison with patients known to have sustained ventricular tachycardia. J Am Coll Cardiol 1999; 34:2023-30. [PMID: 10588219 DOI: 10.1016/s0735-1097(99)00465-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the clinical significance of inducible ventricular tachyarrhythmias among patients with unexplained syncope. BACKGROUND Induction of sustained ventricular arrhythmias at electrophysiology study in patients with unexplained syncope and structural heart disease is usually assigned diagnostic significance. However, the true frequency of subsequent spontaneous ventricular tachyarrhythmias in the absence of antiarrhythmic medications is unknown. METHODS In a retrospective case-control study, the incidence of implantable cardiac defibrillator (ICD) therapies for sustained ventricular arrhythmias among patients with unexplained syncope or near syncope (syncope group, n = 22) was compared with that of a control group of patients (n = 32) with clinically documented sustained ventricular tachycardia (VT). Sustained ventricular arrhythmias were inducible in both groups and neither group received antiarrhythmic medications. All ICDs had stored electrograms or RR intervals. Clinical variables were similar between groups except that congestive cardiac failure was more common in the syncope group. RESULTS Kaplan-Meier analysis of the time to first appropriate ICD therapy for syncope and control groups produced overlapping curves (p = 0.9), with 57 +/- 11% and 50 +/- 9%, respectively, receiving ICD therapy by one year. In both groups, the induced arrhythmia was significantly faster than spontaneous arrhythmias, but the cycle lengths of induced and spontaneous arrhythmias were positively correlated (R = 0.6, p < 0.0001). During follow-up, three cardiac transplantations and seven deaths occurred in the syncope group, and two transplantations and five deaths occurred in the control group (36-month survival without transplant 52 +/- 11% and 83 +/- 7%, respectively, p = 0.03). CONCLUSIONS In patients with unexplained syncope, structural heart disease and inducible sustained ventricular arrhythmias, spontaneous sustained ventricular arrhythmias occur commonly and at a similar rate to patients with documented sustained VT. Thus, electrophysiologic testing in unexplained syncope can identify those at risk of potentially life-threatening tachyarrhythmias, and aggressive treatment of these patients is warranted.
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Affiliation(s)
- N P Andrews
- Electrophysiology Section, The Care Group, LLC, Indianapolis, Indiana 46260, USA
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Mitrani RD, Simmons JD, Interian A, Castellanos A, Myerburg RJ. Cardiac pacemakers: current and future status. Curr Probl Cardiol 1999; 24:341-420. [PMID: 10388947 DOI: 10.1016/s0146-2806(99)90002-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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45
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Link MS, Kim KM, Homoud MK, Estes NA, Wang PJ. Long-term outcome of patients with syncope associated with coronary artery disease and a nondiagnostic electrophysiologic evaluation. Am J Cardiol 1999; 83:1334-7. [PMID: 10235091 DOI: 10.1016/s0002-9149(99)00096-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Syncope in the patient with structural heart disease and a nondiagnostic noninvasive workup is a generally accepted indication for an invasive electrophysiologic study. However, if the electrophysiologic evaluation is not highly sensitive, arrhythmic causes of syncope may not be discovered. In these patients, recurrent syncope and even sudden death may be observed at follow-up. Thus, we evaluated long-term follow-up in 68 consecutive patients who presented with syncope, coronary artery disease, and who had a negative invasive electrophysiologic evaluation. At a mean follow-up of 30 +/- 18 months (range 1 to 65), there have been 2 sudden deaths and 1 episode each of ventricular fibrillation and ventricular tachycardia in patients treated with an implantable cardioverter-defibrillator. All 4 arrhythmias occurred in patients with left ventricular fractions < or = 25%. Seventeen patients had recurrent presyncope or syncope. Bradycardia causing syncope was found in 8 of these patients. A bundle branch block at the initial evaluation predicted for the occurrence of bradycardia at follow-up. We conclude that in patients with coronary artery disease and syncope, noninducibility at electrophysiologic study predicts a lower risk of sudden death and ventricular arrhythmias. However, in patients with a reduced ejection fraction, the risk of sudden death and ventricular arrhythmias remains up to 10%/year and these patients may warrant treatment with implantable cardioverter-defibrillators. Recurrent syncope is common, and frequently a bradyarrhythmia is found to be the cause. Treatment of selected patients (especially those with bundle branch blocks) with permanent pacemakers may be justified.
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Affiliation(s)
- M S Link
- The Cardiac Arrhythmia Center, Tufts University School of Medicine, New England Medical Center, Boston, Massachusetts 02111, USA.
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Olshansky B, Hahn EA, Hartz VL, Prater SP, Mason JW. Clinical significance of syncope in the electrophysiologic study versus electrocardiographic monitoring (ESVEM) trial. The ESVEM Investigators. Am Heart J 1999; 137:878-86. [PMID: 10220637 DOI: 10.1016/s0002-8703(99)70412-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Syncope may portend risk of death, but which patients with syncope are at high risk remains unclear. OBJECTIVE The ESVEM trial, a multicenter randomized prospective trial, provided the opportunity to compare mortality rates of patients enrolled with syncope to those enrolled with spontaneous ventricular arrhythmias. METHODS Patients enrolled in the ESVEM trial presenting with syncope alone (25 patients) or in combination with ventricular tachycardia (24 patients) were compared with patients with spontaneous ventricular tachycardia alone (332 patients) or ventricular fibrillation (105 patients). All patients had ventricular tachyarrhythmias induced at electrophysiology testing of >/=10 premature ventricular complexes per hour on Holter monitor. RESULTS Of all patients randomly assigned, arrhythmic death and total mortality rates were the same for those with syncope alone, with ventricular tachycardia and syncope, with ventricular tachycardia alone, or with ventricular fibrillation. At 1 year, arrhythmic and total mortality rate for all patients was 21% and 24%, respectively; for patients with syncope alone, 30% and 29%, respectively (P = NS). At 4 years, arrhythmic death and total mortality rate for all patients was 33% and 42%, respectively; for patients with syncope alone, 37% and 42%, respectively (P = NS). CONCLUSION Syncope, associated with induced ventricular tachyarrhythmias at electrophysiologic testing, indicates high risk for death, similar to that of patients with documented spontaneous ventricular tachyarrhythmias.
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Affiliation(s)
- B Olshansky
- Division of Cardiology, Loyola University Medical Center, Maywood, IL, 60153, USA
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Eriksson P, Hansson PO, Eriksson H, Dellborg M. Bundle-branch block in a general male population: the study of men born 1913. Circulation 1998; 98:2494-500. [PMID: 9832497 DOI: 10.1161/01.cir.98.22.2494] [Citation(s) in RCA: 168] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Interest in bundle-branch block has focused primarily on its role as a predictor of mortality and coexisting cardiovascular diseases. Previous studies of prevalence, correlation to cardiovascular disease, and mortality have produced conflicting results. METHODS AND RESULTS We studied a random-sampled population of 855 men who were 50 years old in 1963 and followed them up for 30 years with repeated examinations. Men who developed bundle-branch block were studied with regard to cumulative incidence, relationship with cardiovascular disease/risk factors, and survival. The prevalence of bundle-branch block increases from 1% at age 50 years to 17% at age 80 years, resulting in a cumulative incidence of 18%. No significant relationship with ischemic heart disease or mortality was found. Men who would develop bundle-branch block had a bigger heart volume at age 50 years and developed diabetes mellitus and congestive heart disease during follow-up more often than control subjects. CONCLUSIONS Bundle-branch block correlates strongly to age and is common in elderly men. Our results support the theory that bundle-branch block is a marker of a slowly progressing degenerative disease that also affects the myocardium.
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Affiliation(s)
- P Eriksson
- Clinical Experimental Research Laboratory, Section of Preventive Medicine, Department of Medicine, Sahlgrenska University Hospital/Ostra, Göteborg, Sweden
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Englund A, Bergfeldt L, Rosenqvist M. Pharmacological stress testing of the His-Purkinje system in patients with bifascicular block. Pacing Clin Electrophysiol 1998; 21:1979-87. [PMID: 9793094 DOI: 10.1111/j.1540-8159.1998.tb00017.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This literature review, based mainly on the English-language literature, focuses on pharmacological stress testing of the His-Purkinje system as part of an invasive electrophysiological study. The main target group for this investigation is patients with bifascicular block and syncope in which intermittent high grade AV block is suspected. Several drugs have been used for this purpose, mainly Class I antiarrhythmic agents such as ajmaline, procainamide, disopyramide, and flecainide. Most studies, unfortunately, suffer from limited patient numbers, lack of adequate control groups, and/or adequate follow-up. The sensitivity of the disopyramide stress test has been shown to be 75%-100% for prediction of impending high grade AV block. The specificity was > 90%. Studies on procainamide have shown a sensitivity of 60% but the specificity has not been assessed. There are no studies allowing a strict comparison of the diagnostic value of pharmacological provocation with different drugs. Based on the similarities of the electrophysiological effects on the His-Purkinje system of the above Class I agents, it is reasonable to assume that all of them might be of diagnostic value in the present clinical context, provided atrial and ventricular stimulation after drug is included in the protocol.
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Affiliation(s)
- A Englund
- Department of Cardiology, Karolinska Hospital, Karolinska Institute, Stockholm, Sweden
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Aguinaga L, Mont L, Anguera I, Valentino M, Matas M, Brugada J. [Patients with structural heart disease, syncope of unknown etiology and inducible ventricular arrhythmias treated with implantable defibrillators]. Rev Esp Cardiol 1998; 51:566-71. [PMID: 9711105 DOI: 10.1016/s0300-8932(98)74791-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study evaluates the hypothesis that in patients with syncope of unknown origin and heart anomalies, inducible ventricular arrhythmias are specific arrhythmias and therefore should be treated as such. BACKGROUND Although syncope is a frequent clinical entity, the evaluation and treatment of patients with syncope without a clear etiology still remains undefined. Many patients with syncope of undetermined origin undergo invasive electrophysiologic evaluation. Abnormalities of the sinus node, prolongation of conduction times or inducible arrhythmias found during these evaluations are usually assumed to be the cause of syncope, and are consequently treated. However, whether tachyarrhythmias are truly the cause of syncope, and whether treatment of these tachyarrhythmias can prevent recurrent syncope and arrhythmic death, is unknown. PATIENTS AND METHODS An electrophysiological study was performed on 160 patients with structural heart disease and syncope of unknown origin. In 23 out of the 160 patients (16%), programmed electrical stimulation induced sustained ventricular arrhythmias. In 18 out of the 23 patients an automatic defibrillator was implanted and they form the study group. RESULTS In these 18 patients, programmed ventricular stimulation induced sustained monomorphic ventricular tachycardia in 12, sustained polymorphic ventricular tachycardia in 2 and ventricular fibrillation in 4. During a mean follow-up of 14 months, 9 patients received 81 appropriate therapies from the device (53 because of ventricular tachycardia and 23 because of ventricular fibrillation). The probability of appropriate therapy was 100% at 1 year follow-up. There were no episodes of sudden death and 1 patient died of congestive heart failure. CONCLUSIONS In patients with syncope of undetermined origin, heart disease and inducible ventricular tachyarrhythmias treated with a implantable cardioverter defibrillator, there is a high incidence of appropriate therapies. Our results support the practice of using implantable cardioverter defibrillators in patients with syncope of unknown origin, heart disease and inducible ventricular arrhythmias.
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Affiliation(s)
- L Aguinaga
- Unidad de Arritmias, Instituto Clínico de Enfermedades Cardiovasculares, Hospital Clínic, Barcelona
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Abstract
Syncope is by definition a transient event, and its cause has usually resolved by the time the patient is examined. Electrophysiologic testing provides a method for assessing a patient's risk for future arrhythmias based on the known sensitivity and specificity of the analyses of sinus node function, atrioventricular conduction, and responses to programmed atrial and ventricular stimulation. Interpretation of these data must always be made in the context of the patient's total clinical situation.
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Affiliation(s)
- J P DiMarco
- Department of Internal Medicine, University of Virginia School of Medicine, USA
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