Electrophysiologic testing in bundle branch block and unexplained syncope

Morady, Fred; Higgins, James; Peters, Robert W.; Schwartz, Alan B.; Shen, Edward N.; Bhandari, Anil; Scheinman, Melvin M.; Sauvé, Mary Jane

doi:10.1016/0002-9149(84)90254-6

Cited by 138Cardiac electrophysiology and arrhythmiasCardiovascular Syncope and Autonomic DisordersCardiac pacing and defibrillation studies

Electrophysiologic testing in bundle branch block and unexplained syncope

Morady, Fred, Higgins, James, Peters, Robert W., Schwartz, Alan B., Shen, Edward N., Bhandari, Anil, Scheinman, Melvin M., Sauvé, Mary Jane·1984·The American Journal of Cardiology

DOI 10.1016/0002-9149(84)90254-6

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Abstract

Thirty-two patients with bundle branch block and unexplained syncope underwent electrophysiologic testing, including programmed ventricular stimulation with up to triple extrastimuli. The infranodal conduction time (HV) was 70 ms or greater in 12 patients. Pathologic infranodal block during atrial pacing occurred in 2 patients. Unimorphic ventricular tachycardia (VT) was induced in 9 patients (28%) and polymorphic VT in 5 (16%). A permanent pacemaker was implanted in patients with infranodal block during atrial pacing and, generally, in patients with an HV of 70 ms or more. Patients with inducible unimorphic or sustained polymorphic VT were treated with an antiarrhythmic drug. The mean follow-up period was 19 +/- 14 months (+/- standard deviation). Three patients died suddenly: a noncompliant patient with inducible sustained VT; a patient with a normal electrophysiologic study treated empirically with quinidine for premature ventricular complexes; and a patient with an HV of 70 ms and no inducible VT treated with a permanent pacemaker. The actuarial incidence of sudden death was 10% at 45 months of follow-up. Only 2 patients had recurrent syncope; both had a normal electrophysiologic study. Approximately 50% of patients with bundle branch block and unexplained syncope who undergo electrophysiologic testing are found to have a clinically significant abnormality (HV of 70 ms or more, infranodal block during atrial pacing and inducible unimorphic VT), and some patients have more than 1 abnormality. Long-term management guided by the results of electrophysiologic testing generally is successful in preventing recurrent syncope.(ABSTRACT TRUNCATED AT 250 WORDS)

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A high incidence of total deaths, about one-third sudden, occurs in patients with bundle branch block and heart failure, previous myocardial infarction, or low ejection fraction.
“a high incidence of total deaths (about one-third sudden) was observed in patients with BBB and heart failure, previous myocardial infarction, or low ejection fraction. 345-347”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [346]
Syncope is not associated with an increased incidence of sudden death in patients with preserved cardiac function.
“Although syncope is not associated with an increased incidence of sudden death in patients with preserved cardiac function”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [346]
Ventricular programmed stimulation does not seem to identify patients with bundle branch block and heart failure, previous myocardial infarction, or low ejection fraction correctly.
“Unfortunately, ventricular programmed stimulation does not seem to identify these patients correctly”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [346]

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Authors: Morady, F., Higgins, J., Peters, R. W., Schwartz, A. B., Shen, E. N., Bhandari, A., Scheinman, M. M., & Sauvé, M. J.
Affiliations: University of California, San Francisco (US)
Corresponding author: Morady, Fred
ORCID: Peters, Robert W.
Bhandari, Anil
Scheinman, Melvin M.
Venue: The American Journal of Cardiology
Publisher: Elsevier BV
Published: 1984-09
Volume: 54
Issue: 6
Pages: 587-591
ISSN: 0002-9149 (ISSN-L)
DOI: 10.1016/0002-9149(84)90254-6
OpenAlex: W2059208803
Cited by: 138
References: 21
Citations by year: 2026: 1 · 2023: 1 · 2022: 5 · 2021: 4 · 2020: 4 · 2019: 2 · 2018: 9 · 2017: 7 · 2016: 3 · 2012: 2
FWCI: 5.78
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: The American Journal of Cardiology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
Keywords: bundle branch block, unexplained syncope, electrophysiologic testing, programmed ventricular stimulation, polymorphic ventricular tachycardia, permanent pacemaker, antiarrhythmic drugs, sudden death, recurrent syncope, quinidine
MeSH terms: Adolescent, Adult, Aged, Bundle-Branch Block, Cardiac Pacing, Artificial, Child, Death, Sudden, Electrocardiography, Female, Humans, Male, Middle Aged, Pacemaker, Artificial, Syncope, Tachycardia

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Electrophysiologic testing in bundle branch block and unexplained syncope

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