Key result
RBBB and bifascicular block predict ~226% higher pacemaker implantation odds in ILR patients with unexplained syncope.
Why the study?
Predictors of pacemaker requirement in patients with implantable loop recorders and unexplained syncope remain unclear.
What are the clinical and electrocardiographic predictors of pacemaker requirement in patients with unexplained syncope monitored by an implantable loop recorder?
Meta-Analysis (n=4,200)
What are the clinical and electrocardiographic predictors of pacemaker requirement in patients with unexplained syncope monitored by an implantable loop recorder?
Effect estimate: OR 3.264 (95% CI 1.907-5.588)
p-value: p=< .0001
In patients with unexplained syncope and an implantable loop recorder, conduction disorders such as right bundle branch block and bifascicular block strongly predict the subsequent need for a pacemaker.
RBBB and bifascicular block warrant prioritized pacing evaluation in ILR-monitored syncope; extends meta-analytic confirmation of conduction disease as dominant predictor.
Identifying the underlying cause of unexplained syncope is crucial for appropriate management of recurrent syncopal episodes. Implantable loop recorders (ILRs) have emerged as valuable diagnostic tools for monitoring patients with unexplained syncope. However, the predictors of pacemaker requirement in patients with ILR and unexplained syncope remain unclear. In this study, we shed light on these prognostic factors. PubMed/MEDLINE, EMBASE, Web of Science, and Cochrane CENTRAL were systematically searched until May 04, 2023. Studies that evaluated the predictors of pacemaker requirement in patients with implantable loop recorder and unexplained syncope were included. The "Quality In Prognosis Studies" appraisal tool was used for quality assessment. The pooled odds ratio (OR) with 95% confidence intervals (CIs) was calculated. The publication bias was evaluated using Egger's and Begg's tests. Ten studies (n = 4200) were included. Right bundle branch block (OR: 3.264; 95% CI: 1.907-5.588, p < .0001) and bifascicular block (OR: 2.969; 95% CI: 1.859-4.742, p < .0001) were the strongest predictors for pacemaker implantation. Pacemaker requirement was more than two times in patients with atrial fibrillation, sinus bradycardia and first degree AV block. Valvular heart disease, diabetes mellitus, and hypertension were also significantly more in patients with pacemaker implantation. Age (standardized mean difference [SMD]: 0.560; 95% CI: 0.410/0.710, p < .0001) and PR interval (SMD: 0.351; 95% CI: 0.150/0.553, p = .001) were significantly higher in patients with pacemaker requirement. Heart conduction disorders, atrial arrhythmias and underlying medical conditions are main predictors of pacemaker device implantation following loop recorder installation in unexplained syncopal patients.
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Zangiabadian et al. (2024) conducted a meta-analysis in Unexplained syncope (n=4,200). Predictors (e.g., right bundle branch block, bifascicular block) was evaluated on Pacemaker implantation (OR 3.264, 95% CI 1.907-5.588, p=< .0001). Right bundle branch block (OR 3.264; 95% CI 1.907-5.588) and bifascicular block were the strongest predictors of pacemaker implantation in patients with ILRs and unexplained syncope.
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