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Syncope Due to Idiopathic Paroxysmal Atrioventricular Block
Open accessAbstract
Objectives We present data on patients with syncope due to paroxysmal atrioventricular (AV) block unexplainable in terms of currently known mechanisms.Background Paroxysmal AV block is known to be due to intrinsic AV conduction disease or to heightened vagal tone.Methods We evaluated 18 patients presenting with unexplained syncope who had: 1) normal baseline standard electrocardiogram (ECG); 2) absence of structural heart disease; and 3) documentation, by means of prolonged ECG monitoring at the time of syncopal relapse, of paroxysmal third-degree AV block with abrupt onset and absence of other rhythm disturbances before or during the block.Results The study group consisted of 9 men and 9 women, mean age 55 ± 19 years, who had recurrent unexplained syncope for 8 ± 7 years and were subsequently followed up for as long as 14 years (4 ± 4 years on average). The patients had no structural heart disease, standard ECG was normal, and electrophysiological study was negative. In all patients, prolonged ECG monitoring documented paroxysmal complete AV block with 1 or multiple consecutive pauses (mean longest pause: 9 ± 7 s at the time of syncope); AV block occurred without P-P cycle lengthening or PR interval prolongation. During the observation time, no patient had permanent AV block; on permanent cardiac pacing, no patient had further syncopal recurrences.Conclusions Common clinical and electrophysiological features define a distinct form of syncope due to idiopathic paroxysmal AV block characterized by a long history of recurrent syncope, absence of progression to persistent forms of AV block, and efficacy of cardiac pacing therapy.
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“These patients had an otherwise normal heart and no sign of conduction disease on ECG and EPS; they had very low plasma adenosine levels and a high induction rate of transient complete heart block during exogenous injections of adenosine.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [5]
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“Cardiac pacing effectively prevents syncopal recurrences.112,139,140”
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“No syncope recurrence was observed after permanent cardiac pacing over very long periods of follow-up and there was no permanent AV block.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [5]
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“A new clinical entity, called idiopathic AV block, has recently been described in patients with a long history of syncope and in whom paroxysmal AV block could be recorded at the time of syncope recurrence. 5”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [5]
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Developed in collaboration with, European Heart Rhythm Association (EHRA), Heart Failure Association (HFA), and Heart Rhythm Society (HRS), societies, E. B. T. F., European Society of Emergency Medicine (EuSEM), European Federation of Internal Medicine (EFIM), European Union Geriatric Medicine Society (EUGMS), American Geriatrics Society (AGS), European Neurological Society (ENS), et al. (2009) · European Heart Journal · doi:10.1093/eurheartj/ehp298 · Cited by 2,040
Self-citationShryock, J. C., & Belardinelli, L. (1997) · The American Journal of Cardiology · doi:10.1016/s0002-9149(97)00256-7 · Cited by 578
Cardiac electrophysiology of adenosine. Basic and clinical concepts.
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Self-citationParoxysmal atrioventricular block
Lee, S., Wellens, H. J. J., & Josephson, M. E. (2009) · Heart Rhythm · doi:10.1016/j.hrthm.2009.04.001 · Cited by 164
Brignole, M. (2006) · European Heart Journal · doi:10.1093/eurheartj/ehl164 · Cited by 145
Self-citationClemo, H. F., & Belardinelli, L. (1986) · Circulation Research · doi:10.1161/01.res.59.4.427 · Cited by 126
An Implantable Loop Recorder Study of Highly Symptomatic Vasovagal Patients
Deharo, J.-C., Jego, C., Lanteaume, A., & Djiane, P. (2006) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2005.09.043 · Cited by 110
Self-citationBrignole, M., Moya‐Mitjans, À., Menozzi, C., García–Civera, R., & Sutton, R. (2005) · EP Europace · doi:10.1016/j.eupc.2004.11.001 · Cited by 106
Self-citationBrignole, M., Gaggioli, G., Menozzi, C., Gianfranchi, L., Bartoletti, A., Bottoni, N., Lolli, G., Oddone, D., Rosso, A. D., & Pellinghelli, G. (1997) · Circulation · doi:10.1161/01.cir.96.11.3921 · Cited by 98
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Research works printed but not linked: 1
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2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy
Authors Task Force Members, Brignole, M., Auricchio, A., Barón‐Esquivias, G., Bordachar, P., Boriani, G., Breithardt, O. A., Cleland, J. G. F., Deharo, J.-C., Delgado, V., et al. (2013) · European Heart Journal · doi:10.1093/eurheartj/eht150 · Cited by 2,834
Self-citation2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy
Glikson, M., Nielsen, J. C., Kronborg, M. B., Michowitz, Y., Auricchio, A., Barbash, I. M., Barrabés, J. A., Boriani, G., Braunschweig, F., Brignole, M., et al. (2021) · European Heart Journal · doi:10.1093/eurheartj/ehab364 · Cited by 2,019
Self-citation2018 ESC Guidelines for the diagnosis and management of syncope
Brignole, M., Moya, A., de Lange, F. J., Deharo, J.-C., Elliott, P. M., Fanciulli, A., Fedorowski, A., Furlan, R., Kenny, R. A., Martín, A., et al. (2018) · European Heart Journal · doi:10.1093/eurheartj/ehy037 · Cited by 1,951
Self-citation2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy
Authors Task Force Members, Brignole, M., Auricchio, A., Barón‐Esquivias, G., Bordachar, P., Boriani, G., Breithardt, O. A., Cleland, J. G. F., Deharo, J., Delgado, V., et al. (2013) · EP Europace · doi:10.1093/europace/eut206 · Cited by 1,137
Self-citationSheldon, R. S., Grubb, B. P., Olshansky, B., Shen, W.-K., Calkins, H., Brignole, M., Raj, S. R., Krahn, A. D., Morillo, C. A., Stewart, J. M., et al. (2015) · Heart Rhythm · doi:10.1016/j.hrthm.2015.03.029 · Cited by 1,013
“Cardiac pacing effectively prevents syncopal recurrences.(112,139,140) In a small multicenter trial performed on 80 selected elderly patients with unexplained syncope, dual-chamber cardiac pacing significantly reduced 2-year syncopal recurrence from 69% in the control group to 23% in the active group.”
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Metadata
- Authors
- Brignole, M., Deharo, J.-C., De Roy, L., Menozzi, C., Blommaert, D., Dabiri, L., Ruf, J., & Guieu, R.
- Affiliations
- Presidio Ospedaliero (IT)
- Hôpital de la Timone (FR)
- Santa Maria Nuova Hospital (IT)
- CHU Dinant Godinne UCL Namur (BE)
- Corresponding author
- Brignole, Michele
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2011-07
- Volume
- 58
- Issue
- 2
- Pages
- 167-173
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W1692004657
- Semantic Scholar
- 60387dcc854b0991a5c293c6161e7d377c05710b
- Cited by
- 147
- References
- 25
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 4 · 2023: 5 · 2022: 7 · 2021: 11 · 2020: 6 · 2019: 13 · 2018: 13 · 2017: 17 · 2016: 6 · 2015: 9 · 2014: 15 · 2013: 15 · 2012: 11
- FWCI
- 14.72
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Digital Access to Libraries (Université catholique de Louvain (UCL), l'Université de Namur (UNamur) and the Université Saint-Louis (USL-B)) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- syncope, paroxysmal atrioventricular block, complete heart block, cardiac pacing, vagal tone, cardiac conduction disorders, recurrent syncope
- MeSH terms
- Adenosine, Adenosine Triphosphate, Adult, Aged, Electrocardiography, Electrophysiology, Female, Follow-Up Studies, Humans, Male, Middle Aged, Recurrence, Syncope, Time Factors, Atrioventricular Block
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