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Clinical variables do not predict syncope in pacemaker patients with bifascicular block: a SPRITELY substudy.
Joshua Szaszkiewicz1, Robert Sheldon2, Satish Raj1
1Libin Cardiovascular Institute, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2 N 4Z6, Canada.
Summary
In patients with bifascicular block and syncope, a history of asystole, supraventricular tachycardia, or diabetes predicts recurrence. This finding aids in managing syncope resistant to pacing.
Area of Science:
- Cardiology
- Electrophysiology
- Clinical Trials
Background:
- The SPRITELY study found no difference in syncope recurrence between pacemaker and implantable cardiac monitor groups in bifascicular block patients.
- Predictors of syncope recurrence in patients with bifascicular block and permanent pacemakers remain unclear.
Purpose of the Study:
- To identify baseline clinical characteristics that predict syncope recurrence in patients with bifascicular block and a permanent pacemaker.
Main Methods:
- Retrospective analysis of the SPRITELY randomized clinical trial.
- Evaluated 38 baseline clinical variables in 60 patients who received a pacemaker.
- Used univariable and multivariate statistics to identify significant predictors (p < 0.05).
Main Results:
- Recurrent syncope occurred in 12% of patients (20%).
- Angiotensin receptor blockers (ARB) use and a history of asystole, supraventricular tachycardia (SVT), or diabetes were univariable predictors.
- A history of asystole, SVT, or diabetes independently predicted syncope recurrence in multivariate analysis (p = 0.03).
Conclusions:
- In older patients with syncope and bifascicular heart block, a history of asystole, SVT, or diabetes is a significant predictor of syncope recurrence.
- These factors may help identify patients with syncope resistant to pacing.
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