October 23, 2001Circulation
Mechanism of Syncope in Patients With Bundle Branch Block and Negative Electrophysiological Test
Why the study?
Does an implantable loop recorder identify the mechanism of recurrent syncope in patients with bundle branch block and negative electrophysiological study?
Population
52 patients with syncope, bundle branch block, and negative conventional workup
Design
Cohort
Follow-up
3 to 15 months
Authors
Discussion
Loading...
Member takes
Implication
ILR monitoring may document paroxysmal AV block in recurrent syncope after negative EP study in BBB; hypothesis-generating for pacing decisions.
Key Points
- Determine the underlying mechanism of recurrent syncope in patients with bundle branch block who have negative findings on standard electrophysiological testing.
- Monitored 52 patients with bundle branch block and negative conventional diagnostic workups using an implantable loop recorder.
- Followed patients over a period of 3 to 15 months to record heart rhythms during syncopal and presyncopal episodes.
- Syncope recurred in 22 of 52 patients (42%), with heart rhythm successfully captured in 19 patients after a median of 48 days.
- Prolonged asystolic pauses predominantly caused by sudden-onset atrioventricular block occurred in 17 of 19 documented cases (89%), with a median episode duration of 47 seconds.
- Additional events included persistent third-degree atrioventricular block in 3 patients and presyncope related to atrioventricular block with asystole in 2 patients, with zero syncope-related injuries reported.
Structured PICO
Does an implantable loop recorder identify the mechanism of recurrent syncope in patients with bundle branch block and negative electrophysiological study?
P
Population
52 patients with syncope, bundle branch block (BBB), and negative conventional workup (negative electrophysiological test)
I
Intervention
Implantable loop recorder
O
Outcome
Mechanism of recurrent syncope (documented rhythm during event)
In patients with BBB and unexplained syncope after negative EP study, recurrent syncope is predominantly caused by sudden-onset paroxysmal AV block with prolonged asystole, which can be identified via implantable loop recorder.
Cite This Study
Brignole et al. (2001) studied this question.