不明原因晕厥和束支传导阻滞患者的性别差异：女性发生房室传导阻滞的风险较低且心脏起搏需求较少。
Sex-Related Differences in Patients With Unexplained Syncope and Bundle Branch Block: Lower Risk of AV Block and Lesser Need for Cardiac Pacing in Women.
作者信息
Francisco-Pascual Jaume, Rivas-Gándara Nuria, Bach-Oller Montserrat, Badia-Molins Clara, Maymi-Ballesteros Manel, Benito Begoña, Pérez-Rodon Jordi, Santos-Ortega Alba, Sambola-Ayala Antonia, Roca-Luque Ivo, Cantalapiedra-Romero Javier, Rodríguez-Silva Jesús, Pascual-González Gabriel, Moya-Mitjans Àngel, Ferreira-González Ignacio
机构信息
Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.
出版信息
Front Cardiovasc Med. 2022 Feb 25;9:838473. doi: 10.3389/fcvm.2022.838473. eCollection 2022.
OBJECTIVE
To analyze if there are sex-related differences in patients with unexplained syncope and bundle branch block (BBB).
BACKGROUND
Despite increasing awareness that sex is a major determinant of the incidence, etiology, and the outcomes of different arrhythmias, no studies have examined differences in presentation and outcomes between men and women with syncope and BBB.
METHODS
Cohort study of consecutive patients with unexplained syncope and BBB was included from January 2010 to January 2021 with a median follow-up time of 3.4 years [interquartile range (IQR) 1.7-6.0 years]. They were evaluated by a stepwise workup protocol based on electrophysiological study (EPS) and long-term follow-up with an implantable cardiac monitor (ICM).
RESULTS
Of the 443 patients included in the study, 165 (37.2%) were women. Compared with men, women had less diabetes (25.5 vs. 39.9%, = 0.002) and less history of ischemic heart disease (IHD; 13.3 vs. 25.9%, = 0.002). Left bundle branch block (LBBB) was more frequent in women (55.2 vs. 27.7%, < 0.001) while right bundle branch block (RBBB) was more frequent in men (41.5 vs. 67.7%, < 0.001). His to ventricle (HV) interval in the EPS was shorter in women (58 ms [IQR 52-71] vs. 60 ms [IQR 52-73], = 0.035) and less women had an HV interval longer than 70 ms (28.5 vs. 38.1%, = 0.039), however, EPS and ICM offered a similar diagnostic yield in both sexes (40.6 vs. 48.9% and 48.4% vs. 51.1%, respectively). Women had a lower risk of developing atrioventricular block (AVB) (adjusted odds ratio [OR] 0.44-95% CI 0.26-0.74, = 0.002) and of requiring permanent pacemaker implantation (adjusted hazard ratio [HR] 0.72-95% CI: 0.52-0.99, = 0.046). The mortality rate was lower in women (4.5 per 100 person-years [95% CI 3.1-6.4 per 100 person-years] vs. 7.3 per 100 person-years [95% CI 5.9-9.1 per 100 person-years]).
CONCLUSIONS
Compared to men, women with unexplained syncope and BBB have a lower risk of AVB and of requiring cardiac pacing. A stepwise diagnostic approach has a similar diagnostic yield in both sexes, and it seems appropriate to guide the treatment and avoid unnecessary pacemaker implantation, especially in women.
目的
分析不明原因晕厥合并束支传导阻滞（BBB）的患者是否存在性别差异。
背景
尽管人们越来越意识到性别是不同心律失常的发病率、病因及预后的主要决定因素，但尚无研究探讨晕厥合并BBB的男性和女性在临床表现及预后方面的差异。
方法
对2010年1月至2021年1月连续纳入的不明原因晕厥合并BBB患者进行队列研究，中位随访时间为3.4年[四分位间距（IQR）1.7 - 6.0年]。根据电生理研究（EPS）和植入式心脏监测器（ICM）进行的长期随访，采用逐步检查方案对患者进行评估。
结果
该研究纳入的443例患者中，165例（37.2%）为女性。与男性相比，女性患糖尿病的比例较低（25.5%对39.9%，P = 0.002），缺血性心脏病（IHD）病史较少（13.3%对25.9%，P = 0.002）。左束支传导阻滞（LBBB）在女性中更常见（55.2%对27.7%，P < 0.001），而右束支传导阻滞（RBBB）在男性中更常见（41.5%对67.7%，P < 0.001）。女性EPS中的希氏束至心室（HV）间期较短（58 ms [IQR 52 - 71]对60 ms [IQR 52 - 73]，P = 0.035），HV间期大于70 ms的女性比例较低（28.5%对38.1%，P = 0.039），然而，EPS和ICM在两性中的诊断率相似（分别为40.6%对48.9%和48.4%对51.1%）。女性发生房室传导阻滞（AVB）的风险较低（校正比值比[OR] 0.44 - 95%可信区间0.26 - 0.74，P = 0.002），需要植入永久起搏器的风险也较低（校正风险比[HR] 0.72 - 95%可信区间：0.52 - 0.99，P = 0.046）。女性的死亡率较低（每100人年4.5例[95%可信区间每100人年3.1 - 6.4例]对每100人年7.3例[95%可信区间每100人年5.9 - 9.1例]）。
结论
与男性相比，不明原因晕厥合并BBB的女性发生AVB和需要心脏起搏的风险较低。逐步诊断方法在两性中的诊断率相似，似乎适合指导治疗并避免不必要的起搏器植入，尤其是在女性中。
Zotero 插件