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Etiology of syncope in patients with preexisting atrioventricular conduction disorders
Author(s) -
Mitro Peter,
Šimurda Miloš,
Lazúrová Zora,
Jakubová Marta
Publication year - 2020
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.14064
Subject(s) - medicine , etiology , cardiology , asystole , implantable loop recorder , syncope (phonology) , atrioventricular block , sinus bradycardia , left bundle branch block , atrial fibrillation , bradycardia , heart rate , heart failure , blood pressure
Background The discussion about the feasibility of empiric pacemaker implantation in patients with preexisting atrioventricular (AV) conduction disorders continues. The aim of the study was to determine the etiology of syncope and the need for pacemaker insertion in patients with AV conduction impairment using implantable loop recorder (ILR). Methods ILR was implanted after negative diagnostic workup in 37 patients with syncope (24 men, 13 women, age 72 ± 10 years) and preexisting impairment of AV conduction. First‐degree AV block (AVB I) was present in 26 patients, and bundle branch block (BBB) in 17 patients. Results ILR‐based diagnosis was made in 28 patients (75%)—sinus arrest in 13 patients, complete AVB in 10 patients, and vasodepressor syncope in five patients. In patients with preexisting BBB, sinus arrest occurred during ILR monitoring significantly more frequently than in patients without BBB (53% vs 20%, P = .03). Complete AVB was significantly less common in patients with preexisting BBB than in patients without BBB (12% vs 40%, P = .04). On multivariate regression analysis, the only independent predictor of AVB occurrence during ILR monitoring was preexisting AVB I ( P = .03). The only independent predictor of sinus arrest during ILR monitoring was preexisting BBB ( P = .03). Conclusions In patients with preexisting AV conduction disorders, prevailing syncopal mechanism during ILR monitoring was asystole. However, sinus arrest occurred more often than complete AVB and was predicted by preexisting BBB. Preexisting AVB was a predictor of complete AVB during ILR monitoring.