Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
JACC Clin Electrophysiol. 2019 Feb;5(2):212-219. doi: 10.1016/j.jacep.2018.09.015. Epub 2018 Nov 28.
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).
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.
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).
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.
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.
本研究旨在比较普鲁卡因胺和氟卡尼在电生理研究（EPS）中对希氏-浦肯野系统的影响，以强调希氏-浦肯野疾病在晕厥和束支传导阻滞（BBB）患者中的重要性。
晕厥和 BBB 患者有发生房室传导阻滞的风险。建议对有基线正常希氏-心室间隔的患者进行包括 I 类药物挑战的 EPS，以揭示希氏-浦肯野疾病。关于不同 I 类药物之间差异的数据很少。
这是一项在单一中心（2012 年 1 月 1 日至 2017 年 6 月 30 日）进行的所有晕厥和 BBB 患者连续接受 EPS 的前瞻性研究。在那些基线 EPS 阴性的患者中，比较了 2 个队列：A 组（历史队列：普鲁卡因胺）和 B 组（氟卡尼）。
在研究期间，271 名患者（年龄 73.9 ± 12.1 岁，64.9%为男性，QRS 持续时间：139.4 ± 13.9 ms）接受了 EPS。在 166 名患者中，基线 EPS 为阴性并进行了 I 类药物挑战（90 名普鲁卡因胺，76 名氟卡尼）。希氏-心室间隔的最终值和增加百分比（76 ± 16 ms 比 64 ± 10 ms 和 22.5 ± 6.2%比 11.8 ± 5.3%；p<0.001）和诊断率（14.5%比 7.8%，p=0.04）在氟卡尼时更高。在基线特征方面没有发现差异。在随访（25.8 ± 6.3 个月）期间，39 名（24.8%）阴性 EPS 患者（氟卡尼组 19.2%，普鲁卡因胺组 30.1%：相对风险 5.1；95%置信区间 2.6 至 10.2；p<0.001）植入起搏器。
由于希氏-心室间隔的增加更大，氟卡尼在 BBB、晕厥和阴性基线 EPS 的患者中的诊断率高于普鲁卡因胺。此外，在氟卡尼类药物试验阴性的患者中，对起搏器植入的需求较小。
