Skip to main content
SpringerLink
Log in

Syncope and bundle branch block

Diagnostic approach

Synkope und Schenkelblock

Diagnostisches Vorgehen

  • Schwerpunkt
  • Published:
Herzschrittmachertherapie + Elektrophysiologie Aims and scope Submit manuscript

Abstract

Syncope and bundle branch block are reviewed, addressing their specific clinical characteristics, natural history, initial diagnostic approach and the role and limitations of different diagnostic tests with a special focus on electrophysiological studies and implantable loop recorders. A critical review of the different published strategies to be followed in these patients is made and finally an algorithm of how to manage these patients is proposed.

Zusammenfassung

Synkope und Schenkelblock werden beurteilt in Hinblick auf deren spezifische klinische Charakteristika, natürlichen Verlauf und Verfahren zur initialen Diagnostik sowie die Bedeutung und Limitierungen verschiedener diagnostischer Untersuchungen mit speziellem Fokus auf elektrophysiologische Studien und implantierbare Loop-Rekorder. Es erfolgt eine kritische Beurteilung der unterschiedlichen publizierten Strategien bei diesen Patienten, und abschließend wird ein Algorithmus zur Behandlung solcher Patienten vorgeschlagen.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Sagristà-Sauleda J, Romero B, Permanyer-Miralda G et al (1999) Clinical usefulness of head-up tilt test in patients with syncope and intraventricular conduction defect. Europace 1:63–68

    Article  PubMed  Google Scholar 

  2. Moya A, Garcia-Civera R, Croci F et al (2011) Diagnosis, management, and outcomes of patients with syncope and bundle branch block. Eur Heart J 32:1535–1541

    Article  PubMed  PubMed Central  Google Scholar 

  3. McAnulty JH, Rahimtoola SH, Murphy E et al (1982) Natural history of “high-risk” bundle-branch block: final report of a prospective study. N Engl J Med 307:137–143

    Article  CAS  PubMed  Google Scholar 

  4. Quinn J, McDermott D, Stiell I, Kohn M, Wells G (2006) Prospective validation of the San Francisco Syncope Rule to predict patients with serious outcomes. Ann Emerg Med 47:448–454

    Article  PubMed  Google Scholar 

  5. Martin TP, Hanusa BH, Kapoor WN (1997) Risk stratification of patients with syncope. Ann Emerg Med 29:459–466

    Article  CAS  PubMed  Google Scholar 

  6. Del Rosso A, Ungar A, Maggi R et al (2008) Clinical predictors of cardiac syncope at initial evaluation in patients referred urgently to a general hospital: the EGSYS score. Heart 94:1620–1626

    Article  PubMed  Google Scholar 

  7. Colivicchi F, Ammirati F, Melina D, Guido V, Imperoli G, Santini M (2003) Development and prospective validation of a risk stratification system for patients with syncope in the emergency department: the OESIL risk score. Eur Heart J 24:811–819

    Article  PubMed  Google Scholar 

  8. Reed MJ, Newby DE, Coull AJ, Prescott RJ, Jacques KG, Gray AJ (2010) The ROSE (risk stratification of syncope in the emergency department) study. J Am Coll Cardiol 55:713–721

    Article  CAS  PubMed  Google Scholar 

  9. Quinn J, McDermott D (2011) Electrocardiogram findings in emergency department patients with syncope. Acad Emerg Med 18:714–718

    Article  PubMed  Google Scholar 

  10. Pérez-Rodon J, Martínez-Alday J, Barón-Esquivias G et al (2014) Prognostic value of the electrocardiogram in patients with syncope: data from the group for syncope study in the emergency room (GESINUR). Heart Rhythm 11:2035–2044

    Article  PubMed  Google Scholar 

  11. Click RL, Gersh BJ, Sugrue DD et al (1987) Role of invasive electrophysiologic testing in patients with symptomatic bundle branch block. Am J Cardiol 59:817–823

    Article  CAS  PubMed  Google Scholar 

  12. Ezri M, Lerman BB, Marchlinski FE, Buxton AE, Josephson ME (1983) Electrophysiologic evaluation of syncope in patients with bifascicular block. Am Heart J 106:693–697

    Article  CAS  PubMed  Google Scholar 

  13. Morady F, Higgins J, Peters RW et al (1984) Electrophysiologic testing in bundle branch block and unexplained syncope. Am J Cardiol 54:587–591

    Article  CAS  PubMed  Google Scholar 

  14. Brignole M, Menozzi C, Moya A et al (2001) Mechanism of syncope in patients with bundle branch block and negative electrophysiological test. Circulation 104:2045–2050

    Article  CAS  PubMed  Google Scholar 

  15. Twidale N, Heddle WF, Ayres BF, Tonkin AM (1988) Clinical implications of electrophysiology study findings in patients with chronic bifascicular block and syncope. Aust N Z J Med 18:841–847

    Article  CAS  PubMed  Google Scholar 

  16. Martí-Almor J, Cladellas M, Bazán V et al (2010) Nuevos predictores de evolución a bloqueo auriculoventricular en pacientes con bloqueo bifascicular. Rev Esp Cardiol 63:400–408

    Article  PubMed  Google Scholar 

  17. Moya A, Sutton R, Ammirati F et al (2009) Guidelines for the diagnosis and management of syncope (version 2009). Eur Heart J 30:2631–2671

    Article  PubMed  PubMed Central  Google Scholar 

  18. Priori SG, Blomstrom-Lundqvist C, Mazzanti A et al (2015) 2015 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. The task force for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death of the European Society of Cardiology. Eur Heart J 36:2793–2867

    Article  Google Scholar 

  19. Benezet-Mazuecos J, Ibanez B, Rubio JM et al (2007) Utility of in-hospital cardiac remote telemetry in patients with unexplained syncope. Europace 9:1196–1201

    Article  PubMed  Google Scholar 

  20. Scheinman MM, Peters RW, Morady F, Sauve MJ, Malone P, Modin G (1983) Electrophysiologic studies in patients with bundle branch block. Pacing Clin Electrophysiol 6:1157–1165

    Article  CAS  PubMed  Google Scholar 

  21. Roca I, Francisco-Pascual J, Oristrell G et al (2018) Syncope, conduction disturbances and negative electrophysiological test: risk score to predict pacemaker indication in follw-up. Heart Rhythm Scientific Session, Boston, 2018. Abstract #9963

    Google Scholar 

  22. Marti-Almor J, Cladellas M, Bazan V et al (2009) Long-term mortality predictors in patients with chronic bifascicular block. Europace 11:1201–1207

    Article  PubMed  Google Scholar 

  23. Petrac D, Radic B, Birtic K, Gjurovic J (1996) Prospective evaluation of infrahisal second-degree AV block induced by atrial pacing in the presence of chronic bundle branch block and syncope. Pacing Clin Electrophysiol 19:784–792

    Article  CAS  PubMed  Google Scholar 

  24. Tonkin AM, Heddle WF, Tornos P (1978) Intermittent atrioventricular block: procainamide administration as a provocative test. Aust N Z J Med 8:594–602

    Article  CAS  PubMed  Google Scholar 

  25. Bergfeldt L, Edvardsson N, Rosenqvist M, Vallin H, Edhag O (1994) Atrioventricular block progression in patients with bifascicular block assessed by repeated electrocardiography and a bradycardia-detecting pacemaker. Am J Cardiol 74:1129–1132

    Article  CAS  PubMed  Google Scholar 

  26. Olshansky B, Hahn EA, Hartz VL, Prater SP, Mason JW (1999) Clinical significance of syncope in the electrophysiologic study versus electrocardiographic monitoring (ESVEM) trial. The ESVEM investigators. Am Heart J 137:878–886

    Article  CAS  PubMed  Google Scholar 

  27. Link MS, Kim KM, Homoud MK, Estes NA 3rd, Wang PJ (1999) Long-term outcome of patients with syncope associated with coronary artery disease and a nondiagnostic electrophysiologic evaluation. Am J Cardiol 83:1334–1337

    Article  CAS  PubMed  Google Scholar 

  28. Sutton R, Brignole M (2014) Twenty-eight years of research permit reinterpretation of tilt-testing: hypotensive susceptibility rather than diagnosis. Eur Heart J 35:2211–2212

    Article  PubMed  Google Scholar 

  29. Sagrista-Sauleda J, Romero B, Permanyer-Miralda G et al (1999) Clinical usefulness of head-up tilt test in patients with syncope and intraventricular conduction defect. Europace 1:63–68

    Article  CAS  PubMed  Google Scholar 

  30. Locati ET, Moya A, Oliveira M et al (2016) External prolonged electrocardiogram monitoring in unexplained syncope and palpitations: results of the SYNARR-Flash study. Europace 18:1265–1272

    Article  CAS  PubMed  Google Scholar 

  31. Moya A, Brignole M, Sutton R et al (2008) Reproducibility of electrocardiographic findings in patients with suspected reflex neurally-mediated syncope. Am J Cardiol 102:1518–1523

    Article  PubMed  Google Scholar 

  32. Santini M, Castro A, Giada F et al (2013) Prevention of syncope through permanent cardiac pacing in patients with bifascicular block and syncope of unexplained origin: the PRESS study. Circ Arrhythm Electrophysiol 6:101–107

    Article  PubMed  Google Scholar 

  33. Krahn AD, Morillo CA, Kus T et al (2012) Empiric pacemaker compared with a monitoring strategy in patients with syncope and bifascicular conduction blockrationale and design of the Syncope: Pacing or Recording in the Later Years (SPRITELY) study. Europace 14:1044–1048

    Article  PubMed  Google Scholar 

  34. Aste M, Oddone D, Donateo P et al (2016) Syncope in patients paced for atrioventricular block. Europace 18:1735–1739

    Article  PubMed  Google Scholar 

  35. Kalscheur MM, Donateo P, Wenzke KE et al (2016) Long-term outcome of patients with bifascicular block and unexplained syncope following cardiac pacing. Pacing Clin Electrophysiol 39:1126–1131

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Arrhythmia Unit, Cardiology Department, Hospital Universitari Dexeus, Calle Sabino Arana, 5–19—Planta 6, 08028, Barcelona, Spain

    Angel Moya MD PhD FESC & Patricia Fumero MD

  2. Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain

    Angel Moya MD PhD FESC, Nuria Rivas-Gandara MD PhD, Jordi Perez-Rodón MD PhD, Jaume Franciso-Pascual MD, Alba Santos-Ortega MD & Ivo Roca-Luque MD PhD

Authors
  1. Angel Moya MD PhD FESC
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nuria Rivas-Gandara MD PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jordi Perez-Rodón MD PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jaume Franciso-Pascual MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alba Santos-Ortega MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Patricia Fumero MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ivo Roca-Luque MD PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Angel Moya MD PhD FESC.

Ethics declarations

Conflict of interest

A. Moya, N. Rivas-Gandara, J. Perez-Rodón, J. Franciso-Pascual, A. Santos-Ortega, P. Fumero and I. Roca-Luque declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Moya, A., Rivas-Gandara, N., Perez-Rodón, J. et al. Syncope and bundle branch block. Herzschr Elektrophys 29, 161–165 (2018). https://doi.org/10.1007/s00399-018-0560-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00399-018-0560-4

Keywords

Schlüsselwörter

Search

Navigation