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Role of electrophysiological study in patients with syncope and bundle branch block

BACKGROUND: The finding of bundle branch block (BBB) in patients with syncope suggests that paroxysmal atrioventricular block (AVB) or ventricular tachyarrhythmia (VT) may be the cause of syncope. Guidelines for cardiac pacing and cardiac resynchronization therapy have been recommended to perform el...

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Autores principales: Nazari, Neshat, Keykhavani, Ala, Sayah, Sima, Hekmat, Mostafa, Golabchi, Allahyar, Rad, Mohammad Assadian, Alizadeh, Abolfath, Heidarali, Mona
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4274573/
https://www.ncbi.nlm.nih.gov/pubmed/25538780
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author Nazari, Neshat
Keykhavani, Ala
Sayah, Sima
Hekmat, Mostafa
Golabchi, Allahyar
Rad, Mohammad Assadian
Alizadeh, Abolfath
Heidarali, Mona
author_facet Nazari, Neshat
Keykhavani, Ala
Sayah, Sima
Hekmat, Mostafa
Golabchi, Allahyar
Rad, Mohammad Assadian
Alizadeh, Abolfath
Heidarali, Mona
author_sort Nazari, Neshat
collection PubMed
description BACKGROUND: The finding of bundle branch block (BBB) in patients with syncope suggests that paroxysmal atrioventricular block (AVB) or ventricular tachyarrhythmia (VT) may be the cause of syncope. Guidelines for cardiac pacing and cardiac resynchronization therapy have been recommended to perform electrophysiological study (EPS) for confirming main cause of syncope. Therefore, the aim of our study was to evaluate the role of EPS in patients with syncope and BBB. MATERIALS AND METHODS: We evaluated 133 patients (mean age 63 ± 13.8 years) with past history of syncope and BBB from April 2002 to December 2010 who referred to Arrhythmia clinic in two tertiary care centers. All patients underwent EPS on admission time. The frequency distributions of AVB and VT in patients were determined. RESULTS: Left bundle branch block was diagnosed in 184 (82.1%) patients. 133 of them had preserved left ventricular ejection fraction (LVEF ≥45%) that in 91 (68.4%) of those, EPS finding was normal. In 41 (30.8%) patients AVB was reported. In 2 (1.5%) patients VT and atrioventricular nodal reentrant tachycardia were seen. Coronary artery disease was more common in patients with AVB and abnormal EPS finding (P = 0.02). CONCLUSION: Ventricular tachyarrhythmia was a rare electrophysiological finding in those with syncope, bifascicular block, and preserved LVEF. Considering cost-effect benefit, pacemaker or implantable loop recorder implantation is suggested; however, EPS may not be necessary to perform before permanent pacemaker implantation.
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spelling pubmed-42745732014-12-23 Role of electrophysiological study in patients with syncope and bundle branch block Nazari, Neshat Keykhavani, Ala Sayah, Sima Hekmat, Mostafa Golabchi, Allahyar Rad, Mohammad Assadian Alizadeh, Abolfath Heidarali, Mona J Res Med Sci Original Article BACKGROUND: The finding of bundle branch block (BBB) in patients with syncope suggests that paroxysmal atrioventricular block (AVB) or ventricular tachyarrhythmia (VT) may be the cause of syncope. Guidelines for cardiac pacing and cardiac resynchronization therapy have been recommended to perform electrophysiological study (EPS) for confirming main cause of syncope. Therefore, the aim of our study was to evaluate the role of EPS in patients with syncope and BBB. MATERIALS AND METHODS: We evaluated 133 patients (mean age 63 ± 13.8 years) with past history of syncope and BBB from April 2002 to December 2010 who referred to Arrhythmia clinic in two tertiary care centers. All patients underwent EPS on admission time. The frequency distributions of AVB and VT in patients were determined. RESULTS: Left bundle branch block was diagnosed in 184 (82.1%) patients. 133 of them had preserved left ventricular ejection fraction (LVEF ≥45%) that in 91 (68.4%) of those, EPS finding was normal. In 41 (30.8%) patients AVB was reported. In 2 (1.5%) patients VT and atrioventricular nodal reentrant tachycardia were seen. Coronary artery disease was more common in patients with AVB and abnormal EPS finding (P = 0.02). CONCLUSION: Ventricular tachyarrhythmia was a rare electrophysiological finding in those with syncope, bifascicular block, and preserved LVEF. Considering cost-effect benefit, pacemaker or implantable loop recorder implantation is suggested; however, EPS may not be necessary to perform before permanent pacemaker implantation. Medknow Publications & Media Pvt Ltd 2014-10 /pmc/articles/PMC4274573/ /pubmed/25538780 Text en Copyright: © Journal of Research in Medical Sciences http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Nazari, Neshat
Keykhavani, Ala
Sayah, Sima
Hekmat, Mostafa
Golabchi, Allahyar
Rad, Mohammad Assadian
Alizadeh, Abolfath
Heidarali, Mona
Role of electrophysiological study in patients with syncope and bundle branch block
title Role of electrophysiological study in patients with syncope and bundle branch block
title_full Role of electrophysiological study in patients with syncope and bundle branch block
title_fullStr Role of electrophysiological study in patients with syncope and bundle branch block
title_full_unstemmed Role of electrophysiological study in patients with syncope and bundle branch block
title_short Role of electrophysiological study in patients with syncope and bundle branch block
title_sort role of electrophysiological study in patients with syncope and bundle branch block
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4274573/
https://www.ncbi.nlm.nih.gov/pubmed/25538780
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