Document Detail

Mechanism of syncope in patients with bundle branch block and negative electrophysiological test.
MedLine Citation:
PMID:  11673344     Owner:  NLM     Status:  MEDLINE    
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.
M Brignole; C Menozzi; A Moya; R Garcia-Civera; L Mont; M Alvarez; F Errazquin; J Beiras; N Bottoni; P Donateo;
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Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study    
Journal Detail:
Title:  Circulation     Volume:  104     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2001 Oct 
Date Detail:
Created Date:  2001-10-23     Completed Date:  2001-12-04     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2045-50     Citation Subset:  AIM; IM    
Departments of Cardiology, Ospedali Riuniti, Lavagna, Italy.
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MeSH Terms
Bundle-Branch Block / complications*,  physiopathology
Defibrillators, Implantable
Disease-Free Survival
Electrocardiography, Ambulatory* / instrumentation
Electrophysiologic Techniques, Cardiac
Follow-Up Studies
Heart Block / complications,  diagnosis
Heart Conduction System / physiopathology
Predictive Value of Tests
Prospective Studies
Syncope / diagnosis*,  etiology*,  physiopathology
Tilt-Table Test

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