Author + information
- Received August 16, 1995
- Revision received June 15, 1995
- Accepted July 10, 1995
- Published online November 15, 1995.
- Anders Englund, MD*,†,*,
- Lennart Bergfeldt, MD*,
- Nina Rehnqvist, MD, FACC†,
- Hans Åström, MD* and
- Marten Rosenqvist, MD*
- ↵*Address for correspondence:Dr. Anders Englund, Department of Cardiology, Karolinska Hospital, Box 110, S-171 76 Stockholm, Sweden.
Objectives. The aim of this study was to examine the inducibility of ventricular arrhythmias in patients with bifascicular block both with and without a history of syncope and to relate the findings to clinical events during follow-up.
Background. Patients with bifascicular block have an increased risk of sudden death that is not reduced by pacemaker treatment. This risk could be related to a high incidence of ventricular arrhythmias.
Method. Programmed ventricular stimulation was performed in 101 patients with bifascicular block; 41 had a history of unexplained syncope, and 60 were asymptomatic.
Results. Programmed ventricular stimulation resulted in a sustained ventricular arrhythmia in 18 patients (18%), 8 in the syncope group and 10 in the nonsyncope group (p = NS). Three patients in each group had an inducible sustained monomorphic ventricular tachycardia. During a mean follow-up of 21 months, 10 patients experienced a clinical event defined as sudden death (n = 4), syncope (n = 5) or appropriate discharges from an implantable cardioverter-defibrillator (n = 1). Only one of these patients had an inducible ventricular arrhythmia at baseline.
Conclusions. The inducibility of ventricular arrhythmias is high in patients with bifascicular block and of the same magnitude in patients with and without a history of syncope. Clinical events during follow-up were not predicted by programmed ventricular stimulation in either of the two groups. The finding of inducible ventricular arrhythmia in patients with bifascicular block should therefore be interpreted with caution.
This study was supported by grants from the Swedish Heart and Lung Foundation and from the Karolinska Institute, Stockholm, Sweden.
- Received August 16, 1995.
- Revision received June 15, 1995.
- Accepted July 10, 1995.
- American College of Cardiology