Diagnostic value of programmed ventricular stimulation in patients with bifascicular block: a prospective study of patients with and without syncope
Open accessAbstract
Objectives The aim of this study was to examine the inducibility of ventricular arrhythmias in patients with bifascicular block both with and without a history of syncope and to relate the findings to clinical events during follow-up.Background Patients with bifascicular block have an increased risk of sudden death that is not reduced by pacemaker treatment. This risk could be related to a high incidence of ventricular arrhythmias.Method Programmed ventricular stimulation was performed in 101 patients with bifascicular block: 41 had a history of unexplained syncope, and 60 were asymptomatic.Results Programmed ventricular stimulation resulted in a sustained ventricular arrhythmia in 18 patients (18%), 8 in the syncope group and 10 in the nonsyncope group (p = NS). Three patients in each group had an inducible sustained monomorphic ventricular tachycardia. During a mean follow-up of 21 months, 10 patients experienced a clinical event defined as sudden death (n = 4), syncope (n = 5) or appropriate discharges from an implantable cardioverter-defibrillator (n = 1). Only one of these patients had an inducible ventricular arrhythmia at baseline.Conclusions The inducibility of ventricular arrhythmias is high in patients with bifascicular block and of the same magnitude in patients with and without a history of syncope. Clinical events during follow-up were not predicted by programmed ventricular stimulation in either of the two groups. The finding of inducible ventricular arrhythmia in patients with bifascicular block should therefore be interpreted with caution.
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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 [345]
The section on bifascicular block after myocardial infarction reports markedly increased mortality in patients with bundle branch block and prior infarction. The Discussion links lower ejection fraction with death or an appropriate defibrillator discharge. But the Results report that four of five deaths were sudden, not about one-third, and do not establish a high death rate specifically for patients with heart failure. (LLM, conf=0.88)
Experimental — accuracy not yet measuredVentricular 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 [345]
The Discussion and Clinical implications sections say programmed ventricular stimulation had limited prognostic value in patients with bifascicular block; only one of ten patients with a clinical event had an inducible ventricular arrhythmia. The study included patients with heart failure, prior myocardial infarction, and low ejection fraction, but the cited passages do not establish predictive accuracy separately for each of those subgroups (page numbers unavailable). (LLM, conf=0.80)
Experimental — accuracy not yet measuredSyncope 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 [345]
The Results report three sudden deaths in the syncope group and one in the nonsyncope group, but do not compare sudden-death incidence specifically among patients with preserved cardiac function. The Discussion reports a lower mean ejection fraction among patients who died or received an appropriate defibrillator discharge, but that does not establish the claimed association in the preserved-function subgroup. Page numbers are unavailable in our copy. (LLM, conf=0.72)
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- Authors
- Englund, A., Bergfeldt, L., Rehnqvist, N., Åström, H., & Rosenqvist, M.
- Affiliations
- Karolinska University Hospital (SE)
- Danderyds sjukhus (SE)
- Corresponding author
- Englund, Anders
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 1995-11
- Volume
- 26
- Issue
- 6
- Pages
- 1508-1515
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W1974369276
- Cited by
- 96
- References
- 36
- Citations by year
- 2024: 3 · 2023: 1 · 2022: 5 · 2021: 4 · 2020: 5 · 2018: 6 · 2017: 1 · 2016: 1 · 2014: 2 · 2013: 2 · 2012: 3
- FWCI
- 2.75
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Karolinska Institutet
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Keywords
- bifascicular block, programmed ventricular stimulation, ventricular arrhythmia inducibility, syncope, sudden cardiac death, monomorphic ventricular tachycardia, implantable cardioverter-defibrillator, sudden death risk
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Cardiac Pacing, Artificial, Female, Heart Block, Humans, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Sensitivity and Specificity, Syncope
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