![]() ![]() The 2007 European guidelines on cardiac pacing and cardiac resynchronization therapy 5 recommend cardiac pacing in patients with positive EPS (Class I, Level of Evidence C). 2, 3, 4 Electrophysiologic study (EPS) with pharmacologic challenge and long-term monitoring with implantable loop recorders (ILR) are the two essential diagnostic tools in these patients when initial assessment fails to identify the cause of syncope.ĭiagnosis and treatment in these patients with syncope and BBB was recently revised in European Cardiology Society clinical practice guidelines. The presence of bundle branch block (BBB) in the 12-lead electrocardiogram (ECG) indicates paroxysmal atrioventricular block (AVB) as the underlying mechanism of syncope. One particularly interesting subgroup consists of patients attending for syncope and presenting intraventricular conduction delay (IVCD) that compromises ≥1 His bundle fascicles. Although most patients have a benign prognosis because the neurally mediated etiology is the most frequent, high rates of mortality in certain subgroups make it essential to obtain a precise diagnosis and apply adequate treatment. Syncope is a clinical condition responsible for a high rate of emergency room attention and a substantial number of admissions for diagnosis and treatment. El uso escalonado del EEF y del REI en los casos negativos permite alcanzar un rendimiento diagnóstico alto y con seguridad, dado que la TV suele identificarse durante el EEF. ConclusionesĮn pacientes con síncope y BR, la etiología principal está representada por el BAV paroxístico, seguido por la TV. No se observaron TV o muertes arrítmicas durante el seguimiento. El BAV paroxístico fue más frecuente en los pacientes con BR derecha y PR prolongado y/o desviación del eje. La mediana de seguimiento hasta el diagnóstico de BAV paroxístico mediante el REI fue 97 días (intervalo intercuartilo, 60-117 días). Se implantó un REI a 38 pacientes, y se alcanzó un diagnóstico en 13 (34%) el BAV paroxístico fue el más frecuente (n=10). Todos los pacientes con TV tuvieron cardiopatía estructural y mayor prevalencia de BR izquierda. ResultadosĮl EEF fue diagnóstico en 36 pacientes (42%) el mecanismo más frecuente fue el bloqueo auriculoventricular (BAV) paroxístico (n=27), seguido por la taquicardia ventricular (TV) (n=6). Se realizó seguimiento hasta el diagnóstico o el agotamiento de la batería del dispositivo. En aquellos sin indicación de desfibrilador implantable, se implantó un REI. Se realizó un EEF con provocación farmacológica con procainamida en 85 pacientes consecutivos remitidos por síncope y BR tras una evaluación inicial no diagnóstica. The stepped use of EPS and ILR in negative patients enables us to safely achieve a high diagnostic yield, given that VT is usually diagnosed during EPS.Įl objetivo del estudio es evaluar la utilidad de un protocolo diagnóstico escalonado mediante estudio electrofisiológico (EEF) y registrador de eventos implantable (REI) en pacientes con síncope y bloqueo de rama (BR). The most common etiology of syncope in patients with BBB was paroxysmal AVB, followed by VT. We found no occurrence of VT or arrhythmic death during follow-up. Paroxysmal AVB was more frequent in patients with right BBB and prolonged PR interval and/or axis deviation. Median follow-up to diagnosis of paroxysmal AVB was 97 days (interquartile range 60-117 days). Thirty-eight patients received ILRs and diagnosis was achieved in 13 (34%) of them paroxysmal AVB (n=10) was the most frequent diagnosis. All patients with VT had structural heart disease left BBB was more prevalent in this group. The most frequent diagnoses were paroxysmal atrioventricular block (AVB) (n=27), followed by ventricular tachycardia (VT) (n=6). ![]() The EPS was diagnostic in 36 patients (42%). Follow-up continued until diagnosis or end of battery life. ![]() Those patients without indication for defibrillator implantation received ILRs. ![]() MethodsĮighty-five consecutive patients referred for syncope and BBB after initial non-diagnostic assessment underwent EPS including a pharmacological challenge with procainamide. The objective of this study was to determine the diagnostic yield of a stepped protocol involving an electrophysiologic study (EPS) and implantable loop recorders (ILR) in patients with syncope and bundle branch block (BBB). ![]()
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