Long-term outcome of patients with bifascicular block and unexplained syncope following cardiac pacing
Abstract
BACKGROUND: According to the ACC/AHA/HRS guidelines, cardiac pacing is reasonable in patients with bifascicular block (BF-B) and syncope when other causes have been excluded. The purpose of this study was to assess the long-term outcome of patients with BF-B and unexplained syncope following cardiac pacing. METHODS AND RESULTS: Between 2009 and 2015, we identified 43 consecutive patients (mean age of 78 ± 12 years, 64% males) who presented with syncope and BF-B and had received a pacemaker (PM). During a mean follow-up period of 31 ± 21 months, syncope recurred in seven patients (16%): 7% (95% standard error [SE] ± 3%) at 1 year and 18% (95% SE ± 7%) at 5 years. At univariable analysis, the only predictor of syncope recurrence was empiric pacing (P = 0.03). There were no syncope recurrences in the 12 patients who received a PM following a positive electrophysiological study (EPS) and the five patients with documentation of paroxysmal atrioventricular block (AVB) during cardiac monitoring (insertable loop recorder [ILR]), (EPS/ILR Group, n = 17) compared to seven of 26 (27%) patients who received empiric pacing (Empiric Group, n = 26; P = 0.02). Progression to high-degree AVB was documented during follow-up in 16 (37%) patients: nine of 17 (53%) patients in the EPS/ILR Group and seven of 26 (27%) patients in the Empiric Group (P = 0.11). There were no injuries reported during ILR monitoring. CONCLUSIONS: We have shown that syncope recurs not infrequently in patients with BF-B who received pacing for syncope. Nearly one in four patients who had empiric pacing suffered syncope recurrence compared to no recurrences in patients who received a PM following a positive EPS or documentation of transient AVB.
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This finding has been indirectly confirmed by recent studies that showed a significant reduction in syncopal recurrences in patients with prolonged HV implanted with a pacemaker compared with a control group of untreated patients with a negative EPS, or with a control group who received an empiric pacemaker.
“This finding has been indirectly confirmed by recent studies that showed a significant reduction in syncopal recurrences in patients with prolonged HV implanted with a pacemaker compared with a control group of untreated patients with a negative EPS 188 , or with a control group who received an empiric pacemaker. 217”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [217]
Implantation of a pacemaker without documentation of AV block (empirical pacing) exposed patients to the risk of recurrence of syncope in about one-quarter of cases during long-term follow-up and was unnecessary in another half.
“Conversely, implantation of a pacemaker without documentation of AV block (empirical pacing) exposed patients to the risk of recurrence of syncope in about one-quarter of cases during long-term follow-up and was unnecessary in another half. 217,344”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [217]
With a strategy of EPS followed by ILR if EPS findings are unremarkable, a pacemaker was implanted in approximately half of patients and these patients had syncope recurrence after pacemaker implantation in 0-7% of cases.
“With this strategy, a pacemaker was implanted in approximately half of the patients and these patients had syncope recurrence after pacemaker implantation in 0-7% of cases 188,217 .”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [217]
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- Authors
- KALSCHEUR, M. M., DONATEO, P., WENZKE, K. E., ASTE, M., ODDONE, D., SOLANO, A., MAGGI, R., CROCI, F., PAGE, R. L., BRIGNOLE, M., & HAMDAN, M. H.
- Affiliations
- University of Wisconsin–Madison (US)
- Presidio Ospedaliero (IT)
- Corresponding author
- HAMDAN, MOHAMED H.
- ORCID
- Venue
- Pacing and Clinical Electrophysiology
- Publisher
- Wiley
- Published
- 2016-09-22
- Volume
- 39
- Issue
- 10
- Pages
- 1126-1131
- ISSN
- 0147-8389 (ISSN-L)
- 1540-8159
- OpenAlex
- W2518081770
- Cited by
- 32
- References
- 16
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 1 · 2023: 4 · 2022: 3 · 2021: 2 · 2020: 5 · 2019: 4 · 2018: 9 · 2017: 1
- FWCI
- 3.84
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pacing and Clinical Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- bifascicular block, syncope, cardiac pacing, pacemaker implantation, syncope recurrence, paroxysmal atrioventricular block, high-grade atrioventricular block, electrophysiological study, long-term outcomes
- MeSH terms
- Aged, Aged, 80 and over, Cardiac Pacing, Artificial, Female, Follow-Up Studies, Heart Block, Humans, Male, Recurrence, Syncope, Treatment Outcome
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