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

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          Abstract

          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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          Most cited references 14

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          Guidelines for the diagnosis and management of syncope (version 2009).

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            Indications for the use of diagnostic implantable and external ECG loop recorders.

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              Guidelines for cardiac pacing and cardiac resynchronization therapy. The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. Developed in collaboration with the European Heart Rhythm Association.

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                Author and article information

                Journal
                J Res Med Sci
                J Res Med Sci
                JRMS
                Journal of Research in Medical Sciences : The Official Journal of Isfahan University of Medical Sciences
                Medknow Publications & Media Pvt Ltd (India )
                1735-1995
                1735-7136
                October 2014
                : 19
                : 10
                : 961-964
                Affiliations
                Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
                [1 ]Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran
                [2 ]Cardiac Electrophysiology Research Center, Heshmat Cardiovascular Medical and Research Center, Guilan University of Medical Sciences, Rasht, Iran
                [3 ]Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
                Author notes
                Address for correspondence: Dr. Abolfath Alizadeh, Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical Center, Iran University of Medical Science, Niayesh Highway, Vali-e-Asr Street, P. O. Box: 15745-1341, Tehran, Iran. E-mail: alizadeh_73@ 123456yahoo.com
                Article
                JRMS-19-961
                4274573
                Copyright: © Journal of Research in Medical Sciences

                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.

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