Management of Patients With Unexplained Syncope and Bundle Branch Block: Predictive Factors of Recurrent Syncope.
Cureus
; 15(3): e35827, 2023 Mar.
Article
in En
| MEDLINE
| ID: mdl-37033500
ABSTRACT
Syncope in patients with bundle branch block (BBB) is often due to advanced atrioventricular (AV) block. The objective of the present "real-world" study was to evaluate the optimal management in patients with unexplained syncope and BBB and to identify factors that predict the recurrence of syncope. This is a single-center observational prospective registry of 131 consecutive patients undergoing invasive electrophysiology study (EPS) for recurrent unexplained presyncope or syncope attacks and BBB. When the EPS-derived diagnosis was reached, a decision to proceed with a permanent pacemaker was offered to the patient. An implantable loop recorder was inserted in the rest of the population. A total of 131 consecutive patients with unexplained syncope and BBB (67.2% male; age 63.7 ± 16.5 years) underwent EPS during the study period. The distribution of conduction disturbance patterns was as follows isolated left bundle branch block (LBBB) 23.7%; LBBB with first AV block 8.4%; isolated right bundle branch block (RBBB) 10.7%; RBBB with first AV block 8.4%; isolated left anterior/posterior fascicular block 13%; left anterior/posterior fascicular block with first AV block 5.3%; isolated bifascicular block 16.8%; and bifascicular block with first AV block 13.7%. In the multivariate analysis, the only predictors of recurrent syncope were bifascicular block (hazard ratio (HR) 4.16, 95% confidence interval (CI) 1.29, 13.41, P 0.017) and HV interval ≥ 60 msec (HR 3.58, 95% CI 1.12, 11.46, P 0.032). An EPS-based strategy identifies a subset of patients who will benefit from permanent pacing. HV interval ≥ 60 msec and the presence of a bifascicular block were strongly related to syncope recurrence.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Type of study:
Prognostic_studies
/
Risk_factors_studies
Language:
En
Journal:
Cureus
Year:
2023
Document type:
Article
Publication country:
EEUU
/
ESTADOS UNIDOS
/
ESTADOS UNIDOS DA AMERICA
/
EUA
/
UNITED STATES
/
UNITED STATES OF AMERICA
/
US
/
USA