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Bifascicular block in unexplained syncope is underrecognized and under-evaluated: A single-center audit of ESC

Muhammad Asim Shabbir1, Muhammad Hamza Saad Shaukat1, Moiz Ehtesham1

  • 1Department of Internal Medicine, Albany Medical College, Albany, NY, United States of America.

Plos One
|February 28, 2022
PubMed

Insights

Adherence to European Society of Cardiology guidelines for unexplained syncope with bifascicular block is low. Only 10.3% of patients received guideline-directed evaluation, highlighting a gap in care for complete heart block diagnosis.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Internal Medicine

Background:

  • Bifascicular block on ECG can indicate complete heart block as a cause of unexplained syncope.
  • European Society of Cardiology (ESC) guidelines recommend electrophysiology study (EPS) for diagnosis.
  • Pacemaker (PPM) or implantable loop recorder (ILR) are indicated based on EPS results.

Purpose of the Study:

  • To evaluate adherence to ESC guidelines for syncope with bifascicular block.
  • To assess the rate of guideline-directed evaluation in hospitalized patients.

Main Methods:

  • Retrospective audit of adult patients with bifascicular block and unexplained syncope.
  • Inclusion criteria: unexplained syncope, bifascicular block, hospitalization (Jan 2018 - Aug 2019).
  • Assessment of cardiology consults, EPS, ILR, and PPM offers.

Main Results:

  • 11.2% of syncope admissions had bifascicular block; 5% had unexplained syncope.
  • Cardiology consulted in 58.6% of cases; only 2 patients underwent EPS.
  • Guideline-directed evaluation was performed in 10.3% of patients; no empiric PPM was given.

Conclusions:

  • A minority of patients with unexplained syncope and bifascicular block receive guideline-directed evaluation.
  • There is low adherence to ESC recommendations for syncope workup in this patient population.
Abstract

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