Novel Predictors of Progression of Atrioventricular Block in Patients With Chronic Bifascicular Block

Martí-Almor, Julio; Cladellas, M.; Bazán, Víctor; Delclós, Joaquín; Altaba, Carmen; Guijo, Miguel A.; Vila, Joan; Mojal, Sergi; Bruguera, Jordi

doi:10.1016/s1885-5857(10)70088-8

Cited by 16 publications

(22 citation statements)

References 20 publications

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“…In their study, Martí‐Almor and colleagues demonstrated a similar follow‐up period of 4.5 years . Their patient cohort was of comparable age (73 ± 9 years vs 75 ± 9 years, respectively) but included more women (33% vs 17%, respectively).…”

Section: Discussionmentioning

confidence: 78%

Is there a prognostic relevance of electrophysiological studies in bundle branch block patients?

Bogossian

Frommeyer

Göbbert

et al. 2017

Clinical Cardiology

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Background The present European guidelines suggest a diagnostic electrophysiological (EP) study to determine indication for cardiac pacing in patients with bundle branch block and unexplained syncope. We evaluated the prognostic relevance of an EP study for mortality and the development of permanent complete atrioventricular (AV) block in patients with symptomatic bifascicular block and first‐degree AV block. Hypothesis The HV interval is a poor prognostic marker to predict the development of permanent AV block in patients with symptomatic bifascicular block (BFB) and AV block I°. Methods Thirty consecutive patients (mean age, 74.8 ± 8.6 years; 25 males) with symptomatic BFB and first‐degree AV block underwent an EP study before device implantation, according to current guidelines. For 53 ± 31 months, patients underwent yearly follow‐up screening for syncope or higher‐degree AV block. Results Thirty patients presented with prolonged HV interval during the EP study (mean, 82.2 ± 20.1 ms; range, 57–142 ms), classified into 3 groups: group 1, <70 ms (mean, 62 ± 4 ms; range, 57–67 ms; n = 7), group 2, >70 to ≤100 ms (mean, 80 ± 8 ms; range, 70–97 ms; n = 18), and group 3, >100 ms (mean, 119 ± 14 ms; range, 107–142 ms; n = 5). According to the guidelines, patients in groups 2 and 3 received a pacemaker. The length of the HV interval was not associated with the later development of third‐degree AV block or with increased mortality. Conclusions Our present study suggests that an indication for pacemaker implantation based solely on a diagnostic EP study with prolongation of the HV interval is not justified.

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Section: Discussionmentioning

confidence: 78%

Is there a prognostic relevance of electrophysiological studies in bundle branch block patients?

Bogossian

Frommeyer

Göbbert

et al. 2017

Clinical Cardiology

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“…[20][21][22][23][24][25][26][27] Although a thorough assessment of AVB development (especially those of transient nature) was not possible in our study, a conservative estimate for the development of a class IA indication for pacemaker, mainly due to AVB, was found in 13% of patients, with the event occurring most likely within a year from their enrollment. Differences in symptomatic AVB occurrence between the 2 groups showed that AVB was mainly recognized in the DDD30 group; this is explained by the fact that in the DDD60 group all blocks of transitory origin were not detected.…”

Section: Discussionmentioning

confidence: 80%

“…7,20,23,24 In addition, several studies focusing on follow-up of BFB patients with previous syncope reported consistent rates of temporary or permanent AVB development over time. 8,11,[25][26][27][28] Despite the high incidence of electric disturbances of the conduction system, EPS at the time of the hospital observation has limited positive predictive value. 10,14,29,30 Accordingly, BFB patients with both history of previous syncope and a negative EPS have been the subject of several investigations involving pacemakers or loop recorders to identify the nature of associated syncopal recurrences and consequently its most appropriate treatment.…”

Section: Discussionmentioning

confidence: 99%

Prevention of Syncope Through Permanent Cardiac Pacing in Patients With Bifascicular Block and Syncope of Unexplained Origin

Santini

Castro

Giada

et al. 2013

Circ: Arrhythmia and Electrophysiology

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Background— Syncope in patients with bifascicular block (BFB) is a common event whose causes might be difficult to assess. Methods and Results— Prevention of syncope through permanent cardiac pacing in patients with bifascicular block (PRESS) is a multicenter, prospective, randomized, single-blinded study designed to demonstrate a reduction in symptomatic events in patients with bifascicular block and syncope of undetermined origin implanted with permanent pacemaker. Device programming mode (NASPE/BPEG code) at DDD with a lower rate of 60 ppm is compared with backup pacing at DDI with a lower rate of 30 ppm. The end point consisted of (1) syncope, (2) symptomatic presyncopal episodes associated with a device intervention (ventricular pacing), and (3) symptomatic episodes associated with intermittent or permanent atrioventricular block (any degree). One hundred one patients were enrolled and randomized. Primary end point events at 2 years were observed in 23 patients, with a significant lower incidence in the study group (hazard ratio, 0.32; 95% confidence interval [CI], 0.10–0.96; P =0.042). Reduction of any symptoms, associated or not with device intervention, was superior in DDD60 compared with DDI30 (hazard ratio, 0.4; 95% confidence interval, 0.25–0.78; P =0.0053). Fourteen patients developed other rhythm diseases and met class I indication for pacing. The annual incidence of rhythm disease development was 7.4%. Conclusions— In patients with bifascicular block and syncope of undetermined origin, the use of a dual chamber pacemaker programmed to DDD60 led to a significant reduction of syncope or symptomatic events associated with a cardioinhibitory origin, compared with DDI30 programming. Symptoms associated with a new onset of rhythm disease were found in 15% of the population at 2 years.

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“…In the cases of patients with bifascicular block, HV interval is considered to be a useful predictor of AVB (20,21,22,26). Using our validated device, the information granted by HV intervals can be obtained non-invasively under ambulatory conditions at a low-cost.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, progression to high-degree atrioventricular block occurred more frequently in patients with elongated HV intervals than in patients with HV intervals less than 100 ms (20). Moreover, Martí-Almor et al found higher risk of AVB in patients with HV intervals exceeding 64 ms (21). According to a follow-up study involving 227 patients, HV interval can predict "pacemaker need" with a sensitivity of 74% and a specificity of 78% (22).…”

mentioning

confidence: 99%

New Validated Signal-averaging-based Electrocardiography Method to Determine His-ventricle Interval

Németh

Kellényi

Péterfi

et al. 2016

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Novel Predictors of Progression of Atrioventricular Block in Patients With Chronic Bifascicular Block

Cited by 16 publications

References 20 publications

Is there a prognostic relevance of electrophysiological studies in bundle branch block patients?

Is there a prognostic relevance of electrophysiological studies in bundle branch block patients?

Prevention of Syncope Through Permanent Cardiac Pacing in Patients With Bifascicular Block and Syncope of Unexplained Origin

New Validated Signal-averaging-based Electrocardiography Method to Determine His-ventricle Interval

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