Flecainide Versus Procainamide in Electrophysiological Study in Patients With Syncope and Wide QRS Duration
Open accessAbstract
Objectives This study sought to compare the differences between procainamide and flecainide to stress the His-Purkinje system during electrophysiological study (EPS) in patients with syncope and bundle branch block (BBB).Background Patients with syncope and BBB are at risk of developing atrioventricular block. EPS is recommended including class I drug challenge to unmask His-Purkinje disease in cases with baseline normal His-ventricular interval. There is little data on differences between different class I drugs.Methods This was a prospective study of all consecutive patients undergoing EPS for syncope and BBB at a single center (January 1, 2012 to June 30, 2017). Of those patients with negative baseline EPS, 2 cohorts were compared: group A (historical cohort: procainamide) and group B (flecainide).Results During the study, 271 patients (age 73.9 ± 12.1 years, 64.9% male, QRS duration: 139.4 ± 13.9 ms) underwent EPS. In 166, baseline EPS was negative and class I drug challenge was performed (90 procainamide, 76 flecainide). The final value and percentage increase in the His-ventricular interval (76 ± 16 ms vs. 64 ± 10 ms and 22.5 ± 6.2% vs. 11.8 ± 5.3%; p < 0.001) and diagnostic yield (14.5% vs. 7.8%, p = 0.04) were higher with flecainide. No differences were found in baseline characteristics. During follow-up (25.8 ± 6.3 months), 39 patients (24.8%) with negative EPS (19.2% with flecainide vs. 30.1% with procainamide: relative risk: 5.1; 95% confidence interval: 2.6 to 10.2; p < 0. 001) received a pacemaker.Conclusions Flecainide has a higher diagnostic yield than does procainamide in patients with BBB, syncope, and negative baseline EPS due to a greater increase of the His-ventricular interval. Additionally, there is a lesser need for pacemaker implantation in patients in whom the class I drug test using flecainide was negative.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Flecainide is often utilized as a drug challenge during electrophysiological studies to reveal His-Purkinje disease in cases with a wide QRS complex, syncope, and a normal HV interval, as evidenced by a drug-induced increase in the HV interval to more than 100 ms.
“Specifically, flecainide is often utilized as a drug challenge during electrophysiological studies to reveal His‐Purkinje disease in cases with a wide QRS complex, syncope, and a normal HV interval, as evidenced by a drug‐induced increase in the HV interval to more than 100 ms [22].”
From Clinical Significance and Management of Atrioventricular Block Associated With Bradycardic/Antiarrhythmic Drug Therapy: Drug-Induced or Drug-Revealed? (2025) · cites this paper as [22]
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
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 · see citing works
2018 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 · see citing works
Brugada Syndrome: Report of the Second Consensus Conference
Antzelevitch, C. N., Brugada, P., Borggrefe, M. M., Brugada, J., Brugada, R., Corrado, D., Gussak, I. B., Marec, H. L., Nademanee, K., Pérez‐Riera, A. R., et al. (2005) · Circulation · doi:10.1161/01.cir.0000152479.54298.51 · Cited by 1,807 · see citing works
Incidence and Prognosis of Syncope
Soteriades, E. S., Evans, J. C., Larson, M. G., Chen, M. H., Chen, L., Benjamin, E. J., & Levy, D. (2002) · New England Journal of Medicine · doi:10.1056/nejmoa012407 · Cited by 1,364 · see citing works
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., Delgado, V., et al. (2013) · EP Europace · doi:10.1093/europace/eut206 · Cited by 1,125 · see citing works
2018 ESC Guidelines for the diagnosis and management of syncope
Brignole, M., Moya‐Mitjans, À., de Lange, F. J., Deharo, J., Elliot, P. M., Fanciulli, A., Fedorowski, A., Furlan, R., Kenny, R. A., Martiın, A., et al. (2018) · Kardiologia Polska · doi:10.5603/kp.2018.0161 · Cited by 474 · see citing works
Mechanism of syncope in patients with bundle branch block and negative electrophysiological test
Brignole, M., Menozzi, C., Moya, A., Garcia-Civera, R., Mont, L., Alvarez, M., Errazquin, F., Beiras, J., Bottoni, N., Donateo, P., et al. (2001) · Circulation · doi:10.1161/hc4201.097837 · Cited by 328 · see citing works
2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope
Shen, W.-K., Sheldon, R. S., Benditt, D. G., Cohen, M. I., Forman, D. E., Goldberger, Z. D., Grubb, B. P., Hamdan, M. H., Krahn, A. D., Link, M. S., et al. (2017) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2017.03.003 · Cited by 327 · see citing works
2013 ESC Guidelines on Cardiac Pacing and Cardiac Resynchronization Therapy
Brignole, M., Auricchio, A., Barón‐Esquivias, G., Bordachar, P., Boriani, G., Breithardt, O. A., Cleland, J. G. F., Deharo, J.-C., Delgado, V., Elliott, P. M., et al. (2014) · Revista Española de Cardiología (English Edition) · doi:10.1016/j.rec.2013.11.003 · Cited by 198 · see citing works
Significance of the HV interval in 517 patients with chronic bifascicular block.
Dhingra, R. C., Palileo, E. A., Strasberg, B., Swiryn, S., Bauernfeind, R. A., Wyndham, C. R. C., & Rosen, K. M. (1981) · Circulation · doi:10.1161/01.cir.64.6.1265 · Cited by 177 · see citing works
Dhingra, R. C., Wyndham, C. R. C., Bauernfeind, R. A., Swiryn, S., DEEDWANIA, P. C., Smith, T., DENES, P., & Rosen, K. M. (1979) · Circulation · doi:10.1161/01.cir.60.7.1455 · Cited by 160 · see citing works
ESC Guidelines on cardiac pacing and cardiac resynchronization therapy
Nielsen, J. C., Petersen, H. H., Karlsen, F. M., Chri, L. S., & Haarbo, J. (2014) · Cited by 146 · see citing works
Prognostic value of infranodal conduction time in patients with chronic bundle branch block.
Scheinman, M. M., Peters, R. W., Modin, G. W., Brennan, M., Mies, C., & O'Young, J. (1977) · Circulation · doi:10.1161/01.cir.56.2.240 · Cited by 140 · see citing works
Diagnosis, management, and outcomes of patients with syncope and bundle branch block
Moya, A., Garcia-Civera, R., Croci, F., Menozzi, C., Brugada, J., Ammirati, F., Del Rosso, A., Bellver-Navarro, A., Garcia-Sacristan, J., Bortnik, M., et al. (2011) · European Heart Journal · doi:10.1093/eurheartj/ehr071 · Cited by 124 · see citing works
Role of invasive electrophysiologic testing in patients with symptomatic bundle branch block
Click, R. L., Gersh, B. J., SUGRUE, D. D., Holmes, D. R., Wood, D. L., Osborn, M. J., & Hammill, S. C. (1987) · The American Journal of Cardiology · doi:10.1016/0002-9149(87)91098-8 · Cited by 93 · see citing works
Prognosis Among Healthy Individuals Discharged With a Primary Diagnosis of Syncope
Ruwald, M. H., Hansen, M. L., Lamberts, M., Hansen, C. M., Vinther, M., Køber, L., Torp-Pedersen, C. T., Hansen, J., & Gislason, G. (2012) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2012.08.1024 · Cited by 87 · see citing works
Santini, M., Castro, A., Giada, F., Ricci, R., Inama, G., Gaggioli, G., Calò, L., Orazi, S., Viscusi, M., Chiodi, L., et al. (2013) · Circulation: Arrhythmia and Electrophysiology · doi:10.1161/circep.112.975102 · Cited by 84 · see citing works
Prospective observations in patients with chronic bundle branch block and marked H-V prolongation.
Dhingra, R. C., DENES, P., Wu, D., Wyndham, C. R. C., AMAT-Y-LEON, F., Towne, W. D., & Rosen, K. M. (1976) · Circulation · doi:10.1161/01.cir.53.4.600 · Cited by 74 · see citing works
Implications of mechanism of bradycardia on response to pacing in patients with unexplained syncope
Sud, S., Klein, G. J., Skanes, A. C., Gula, L. J., Yee, R., & Krahn, A. D. (2007) · EP Europace · doi:10.1093/europace/eum020 · Cited by 66 · see citing works
Twidale, N., HEDDLE, W. F., & Tonkin, A. M. (1988) · PubMed · Cited by 54 · see citing works
Intermittent Atrioventricular Block: Procainamide Administration as a Provocative Test*
Tonkin, A. M., HEDDLE, W. F., & Tornos, P. (1978) · Australian and New Zealand Journal of Medicine · doi:10.1111/j.1445-5994.1978.tb04846.x · Cited by 52 · see citing works
Pharmacological Stress Testing of the His‐Purkinje System in Patients with Bifascicular Block
ENCLUND, A., Bergfeldt, L., & Rosenqvist, M. (1998) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.1998.tb00017.x · Cited by 45 · see citing works
Nuevos predictores de evolución a bloqueo auriculoventricular en pacientes con bloqueo bifascicular
Martí‐Almor, J., Cladellas, M., Bazán, V., Delclós, J., Altaba, C., Guijo, M. A., Vila, J., Mojal, S., & Bruguera, J. (2010) · Revista Española de Cardiología · doi:10.1016/s0300-8932(10)70060-9 · Cited by 31 · see citing works
Martí‐Almor, J., Cladellas, M., Bazán, V., Delclós, J., Altaba, C., Guijo, M. A., Vila, J., Mojal, S., & Bruguera, J. (2010) · Revista Española de Cardiología (English Edition) · doi:10.1016/s1885-5857(10)70088-8 · Cited by 23 · see citing works
Englund, A., Bergfeldt, L., & Rosenqvist, M. (1995) · Heart · doi:10.1136/hrt.74.6.650 · Cited by 22 · see citing works
Pentimalli, F., Bacino, L., Ghione, M., Siri, G., Gazzarata, M., & Bellotti, P. (2016) · Europe PMC (PubMed Central) · doi:10.4022/jafib.1421 · Cited by 5 · see citing works
Nattel, S. (2005) · Heart Rhythm · doi:10.1016/j.hrthm.2004.12.006 · Cited by 4 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
2021 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 · see citing works
2021 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) · EP Europace · doi:10.1093/europace/euab232 · Cited by 927 · see citing works
Roca‐Luque, I., Pascual, J. F., Oristrell, G., Rodríguez‐García, J., Santos‐Ortega, A., Martín-Sánchez, G., Rivas‐Gándara, N., Pérez‐Rodon, J., González, I. F., García‐Dorado, D., et al. (2018) · Heart Rhythm · doi:10.1016/j.hrthm.2018.12.015 · Cited by 30 · see citing works
Self-citationArrhythmic syncope: From diagnosis to management
Pascual, J. F., Jordán, P., Silva, J. R., & Rivas‐Gándara, N. (2023) · World Journal of Cardiology · doi:10.4330/wjc.v15.i4.119 · Cited by 28 · see citing works
Guía ESC 2021 sobre estimulación cardiaca y terapia de resincronización
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. (2022) · Revista Española de Cardiología · doi:10.1016/j.recesp.2021.10.025 · Cited by 26 · see citing works
Cardiac monitoring for patients with palpitations
Pascual, J. F., Romero, J. C., Pérez‐Rodon, J., Benito, B., Santos‐Ortega, A., Maldonado, J., González, I. F., & Rivas‐Gándara, N. (2021) · World Journal of Cardiology · doi:10.4330/wjc.v13.i11.608 · Cited by 23 · see citing works
Self-citationPascual, J. F., Rivas‐Gándara, N., Bach-Oller, M., Badia-Molins, C., Ballesteros, M. M., Benito, B., Pérez‐Rodon, J., Santos‐Ortega, A., Sambola, A., Roca‐Luque, I., et al. (2022) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2022.838473 · Cited by 14 · see citing works
Self-citationPascual, J. F., Ródenas‐Alesina, E., Rivas‐Gándara, N., Belahnech, Y., Olivella, A., Pérez‐Rodon, J., Benito, B., Santos‐Ortega, A., Moya‐Mitjans, À., Casas, G., et al. (2020) · Heart Rhythm · doi:10.1016/j.hrthm.2020.12.009 · Cited by 13 · see citing works
Self-citationTachyarrhythmias in congenital heart disease
Pascual, J. F., Mallofré, N., Santos‐Ortega, A., & Rivas‐Gándara, N. (2024) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2024.1395210 · Cited by 9 · see citing works
Self-citationCharacterization of reflex syncope in Brugada syndrome: a literature review
Mascia, G., Barca, L., Brugada, J., Arbelo, E., Monaco, C., Vlachos, K. G., Xhakupi, H., Fazia, M. L., Russo, V., Scarà, A., et al. (2025) · Journal of Cardiovascular Medicine · doi:10.2459/jcm.0000000000001758 · Cited by 8 · see citing works
Doundoulakis, I., Tsiachris, D., Kordalis, A., Σουλαϊδόπουλος, Σ., Αρσένος, Π., Xintarakou, A., Koliastasis, L., Vlachakis, P. K., Tsioufis, K. P., & Gatzoulis, K. A. (2023) · Cureus · doi:10.7759/cureus.35827 · Cited by 6 · see citing works
Barold, S. S., & Herweg, B. (2024) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2024.1450705 · Cited by 5 · see citing works
Pascual, J. F., Rivas‐Gándara, N., Ballesteros, M. M., Badia-Molins, C., Bach-Oller, M., Benito, B., Pérez‐Rodon, J., Santos‐Ortega, A., Roca‐Luque, I., Rodríguez-Silva, J., et al. (2022) · Revista Española de Cardiología (English Edition) · doi:10.1016/j.rec.2022.11.009 · Cited by 4 · see citing works
Self-citationPascual, J. F., Rivas‐Gándara, N., Ballesteros, M. M., Badia-Molins, C., Bach-Oller, M., Benito, B., Pérez‐Rodon, J., Santos‐Ortega, A., Roca‐Luque, I., Rodríguez-Silva, J., et al. (2023) · Revista Española de Cardiología · doi:10.1016/j.recesp.2022.11.010 · Cited by 4 · see citing works
Self-citationSfairopoulos, D., Bazoukis, G., Sideris, S., Fragakis, N., Letsas, K., Zekios, K., Liu, T., & Korantzopoulos, P. (2025) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.16697 · Cited by 3 · see citing works
“Specifically, flecainide is often utilized as a drug challenge during electrophysiological studies to reveal His ‐ Purkinje disease in cases with a wide QRS complex, syncope, and a normal HV interval, as evidenced by a drug ‐ induced increase in the HV interval to more than 100 ms [22].”
Pascual, J. F., Rivas‐Gándara, N., Santos‐Ortega, A., Pérez‐Rodon, J., Benito, B., Belahnech, Y., & González, I. F. (2021) · Medicina Clínica · doi:10.1016/j.medcli.2020.12.005 · Cited by 3 · see citing works
Self-citationPascual, J. F., Rivas‐Gándara, N., Santos‐Ortega, A., Pérez‐Rodon, J., Benito, B., Belahnech, Y., & González, I. F. (2021) · Medicina Clínica (English Edition) · doi:10.1016/j.medcle.2020.12.017 · Cited by 3 · see citing works
Self-citationTáborský, M., Kautzner, J., Fedorco, M., Čurila, K., Wünschová, H., Pyszko, J., Novák, M., Kozák, M., Válek, M., Polášek, R., et al. (2022) · Cor et Vasa · doi:10.33678/cor.2022.024 · Cited by 2 · see citing works
Pascual, J. F., & Estrada, N. L.-T. (2024) · Medicina Clínica · doi:10.1016/j.medcli.2023.12.014 · Cited by 2 · see citing works
Flecainide to Unmask Infranodal Disease
Lokhandwala, Y. Y., & Kumar, B. (2019) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2018.10.012 · Cited by 2 · see citing works
Sabra, M., Kabani, S., & Maskoun, W. (2024) · Heart Rhythm O2 · doi:10.1016/j.hroo.2024.07.002 · Cited by 1 · see citing works
Doundoulakis, I., Nakasone, K., Bala, G., Sieira, J. A., Overeinder, I., Sarkozy, A., Chierchia, G., Brugada, P., de Asmundis, C., & Ströker, E. (2024) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2024.09.037 · Cited by 1 · see citing works
Impact of flecainide on left bundle branch capture criteria
Shadrin, I. Y., & Friedman, D. J. (2023) · HeartRhythm Case Reports · doi:10.1016/j.hrcr.2023.11.010 · Cited by 1 · see citing works
Pascual, J. F., Medina-Maguiña, J. M., & Rivas‐Gándara, N. (2025) · Medicina Clínica (English Edition) · doi:10.1016/j.medcli.2025.107107 · Cited by 1 · see citing works
Bloqueo auriculoventricular permanente tras test de flecainida
Luna‐López, R., Datino, T., Espinosa, M. Á., Fernández‐Avilés, F., & Arenal, Á. (2019) · Revista Española de Cardiología · doi:10.1016/j.recesp.2019.06.020
Permanent atrioventricular block after flecainide testing
Luna‐López, R., Datino, T., Espinosa, M. Á., Fernández‐Avilés, F., & Arenal, Á. (2019) · Revista Española de Cardiología (English Edition) · doi:10.1016/j.rec.2019.06.016
Pascual, J. F., & Estrada, N. L.-T. (2024) · Medicina Clínica (English Edition) · doi:10.1016/j.medcle.2023.12.016
- Authors
- Roca-Luque, I., Francisco-Pasqual, J., Oristrell, G., Rodríguez-García, J., Santos-Ortega, A., Martin-Sanchez, G., Rivas-Gandara, N., Perez-Rodon, J., Ferreira-Gonzalez, I., García-Dorado, D., & Moya-Mitjans, A.
- Affiliations
- Vall d'Hebron Hospital Universitari (ES)
- ORCID
- Oristrell, Gerard
- Venue
- JACC: Clinical Electrophysiology
- Publisher
- Elsevier BV
- Published
- 2019-02
- Volume
- 5
- Issue
- 2
- Pages
- 212-219
- ISSN
- 2405-500X (ISSN-L)
- OpenAlex
- W2902407339
- Cited by
- 28
- References
- 27
- Citations by year
- 2025: 4 · 2024: 6 · 2023: 4 · 2022: 4 · 2021: 5 · 2020: 1 · 2019: 3 · 2018: 1
- FWCI
- 2.60
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- JACC. Clinical electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- European Regional Development Fund
- Instituto de Salud Carlos III
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Keywords
- flecainide, procainamide, syncope, bundle branch block, His-Purkinje system, His-ventricular interval, class I antiarrhythmic drugs, drug challenge, atrioventricular block, pacemaker implantation, diagnostic yield, electrophysiological study, ventricular conduction block, atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia
- MeSH terms
- Aged, Aged, 80 and over, Bundle-Branch Block, Electrocardiography, Female, Flecainide, Heart Conduction System, Humans, Male, Middle Aged, Procainamide, Syncope, Electrophysiologic Techniques, Cardiac
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
