Key result
Electrophysiological study-guided treatment was associated with a significantly higher risk of syncope recurrence (29.3% vs 5.6%, HR 6.24) compared to empirical pacemaker implantation in patients with bifascicular block.
Why the study?
The optimal treatment of patients with bifascicular block and syncope in the absence of structural heart disease is not well defined.
Does empirical pacemaker implantation improve clinical outcomes compared to EPS-guided treatment in patients with unexplained cardiogenic syncope and bifascicular block without structural heart disease?
Cohort (n=77)
Yes
Does empirical pacemaker implantation improve clinical outcomes compared to EPS-guided treatment in patients with unexplained cardiogenic syncope and bifascicular block without structural heart disease?
Hazard Ratio: 6.24 (95% CI 1.26–30.97)
Absolute Event Rate: 29.3% vs 5.6%
p-value: p=0.025
In patients with unexplained syncope and bifascicular block without structural heart disease, empirical pacemaker implantation reduces syncope recurrence and AV block compared to an EPS-guided strategy.
Empiric pacing was associated with fewer recurrences than EPS guidance in BFB syncope without SHD; leaves open whether RCTs should prioritize empiric strategy.
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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Rivera-López et al. (2020) conducted a cohort in Unexplained syncope and bifascicular block without structural heart disease (n=77). Electrophysiological study (EPS) guided treatment vs. Empirical pacemaker implantation was evaluated on Syncope recurrence (HR 6.24, 95% CI 1.26-30.97, p=0.025). Electrophysiological study-guided treatment was associated with a significantly higher risk of syncope recurrence (29.3% vs 5.6%, HR 6.24) compared to empirical pacemaker implantation in patients with bifascicular block.
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