Nazari Neshat, Keykhavani Ala, Sayah Sima, Hekmat Mostafa, Golabchi Allahyar, Rad Mohammad Assadian, Alizadeh Abolfath, Heidarali Mona
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran.
J Res Med Sci. 2014 Oct;19(10):961-4.
The finding of bundle branch block (BBB) in patients with syncope suggests that paroxysmal atrioventricular block (AVB) or ventricular tachyarrhythmia (VT) may be the cause of syncope. Guidelines for cardiac pacing and cardiac resynchronization therapy have been recommended to perform electrophysiological study (EPS) for confirming main cause of syncope. Therefore, the aim of our study was to evaluate the role of EPS in patients with syncope and BBB.
We evaluated 133 patients (mean age 63 ± 13.8 years) with past history of syncope and BBB from April 2002 to December 2010 who referred to Arrhythmia clinic in two tertiary care centers. All patients underwent EPS on admission time. The frequency distributions of AVB and VT in patients were determined.
Left bundle branch block was diagnosed in 184 (82.1%) patients. 133 of them had preserved left ventricular ejection fraction (LVEF ≥45%) that in 91 (68.4%) of those, EPS finding was normal. In 41 (30.8%) patients AVB was reported. In 2 (1.5%) patients VT and atrioventricular nodal reentrant tachycardia were seen. Coronary artery disease was more common in patients with AVB and abnormal EPS finding (P = 0.02).
Ventricular tachyarrhythmia was a rare electrophysiological finding in those with syncope, bifascicular block, and preserved LVEF. Considering cost-effect benefit, pacemaker or implantable loop recorder implantation is suggested; however, EPS may not be necessary to perform before permanent pacemaker implantation.
在晕厥患者中发现束支传导阻滞（BBB）提示阵发性房室传导阻滞（AVB）或室性快速性心律失常（VT）可能是晕厥的原因。心脏起搏和心脏再同步治疗指南建议进行电生理检查（EPS）以确认晕厥的主要原因。因此，我们研究的目的是评估EPS在晕厥合并BBB患者中的作用。
我们评估了2002年4月至2010年12月期间转诊至两个三级医疗中心心律失常门诊的133例有晕厥病史和BBB的患者（平均年龄63±13.8岁）。所有患者入院时均接受了EPS检查。确定患者中AVB和VT的频率分布。
184例（82.1%）患者诊断为左束支传导阻滞。其中133例左心室射血分数保留（LVEF≥45%），其中91例（68.4%）EPS检查结果正常。41例（30.8%）患者报告有AVB。2例（1.5%）患者出现VT和房室结折返性心动过速。AVB和EPS检查结果异常的患者中冠状动脉疾病更常见（P = 0.02）。
室性快速性心律失常在晕厥、双分支传导阻滞和LVEF保留的患者中是一种罕见的电生理表现。考虑到成本效益，建议植入起搏器或植入式环路记录器；然而，在植入永久起搏器之前可能没有必要进行EPS检查。
