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Europace 2002 4(4):357-360; doi:10.1053/eupc.2002.0265
© 2002 by European Society of Cardiology
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A standardized conventional evaluation of the mechanism of syncope in patients with bundle branch block

P. Donateo1, M. Brignole1, P. Alboni2, C. Menozzi3, A. Raviele4, A. Del Rosso5, M. Dinelli2, A. Solano1, N. Bottoni3 and F. Croci1

1Department of Cardiology, Ospedali Riuniti Lavagna, Italy; 2Department of Cardiology, Ospedale Civile Cento, Italy; 3Department of Cardiology, Ospedale S Maria Nuova Reggio Emilia, Italy; 4Department of Cardiology, Ospedale Umberto I Mestre, Italy; 5Department of Cardiology, Ospedale S Pietro Igneo Fucecchio, Italy

BACKGROUND: The finding of bundle branch block in patients with syncope suggests that paroxysmal AV block may be the cause of syncope, even though its prevalence is unknown.

METHODS: We evaluated 55 consecutive patients with syncope and bundle branch block (mean age 75±8 years; median of two syncopal episodes per patient) referred to three Syncope Units. The hierarchy and appropriateness of diagnostic tests and the definitions of the final diagnoses followed standardized predefined criteria.

RESULTS: Cardiac syncope was diagnosed in 25 patients (45%): AV block in 20, sick sinus syndrome in 2, sustained ventricular tachycardia in 1, aortic stenosis in 2. Neurally mediated syncope was diagnosed in 22 (40%): carotid sinus syndrome in 5, tilt-induced syncope in 15, adenosine-sensitive syncope in 2. Syncope remained unexplained in 8 (15%).

CONCLUSIONS: Less than half of the patients with bundle branch block have a final diagnosis of cardiac syncope; in these patients, paroxysmal AV block is the most frequent but not the only mechanism supposed.

Key Words: Syncope, bundle branch block, structural heart disease, ventricular tachyarrhythmias, carotid sinus syndrome, cardiac conduction tissue disease

Correspondence: Paolo Donateo, MD, Department of Cardiology, Arrhythmologic Centre, Hospital of Lavagna, Italy. Via D. Bobbio. Tel.: +39 0185 329569. Fax: +39 0185 306506. E-mail: aritmo{at}asl4.liguria.it


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