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Mårten Rosenqvist - One of the best experts on this subject based on the ideXlab platform.
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time relation between a syncopal event and documentation of atrioventricular Block in patients with Bifascicular Block clinical implications
The Cardiology, 2007Co-Authors: Fariborz Tabrizi, Lennart Bergfeldt, Mårten Rosenqvist, Anders EnglundAbstract:Background: Transient high-degree atrioventricular (AV) Block is a common cause of syncope in patients with Bifascicular Block (BFB) but the intermittent nature of AV Block makes EC
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Pharmacological stress testing of the His-Purkinje system in patients with Bifascicular Block.
Pacing and Clinical Electrophysiology, 1998Co-Authors: Anders Enclund, Lennart Bergfeldt, Mårten RosenqvistAbstract:: This literature review, based mainly on the English-language literature, focuses on pharmacological stress testing of the His-Purkinje system as part of an invasive electrophysiological study. The main target group for this investigation is patients with Bifascicular Block and syncope in which intermittent high grade AV Block is suspected. Several drugs have been used for this purpose, mainly Class I antiarrhythmic agents such as ajmaline, procainamide, disopyramide, and flecainide. Most studies, unfortunately, suffer from limited patient numbers, lack of adequate control groups, and/or adequate follow-up. The sensitivity of the disopyramide stress test has been shown to be 75%-100% for prediction of impending high grade AV Block. The specificity was > 90%. Studies on procainamide have shown a sensitivity of 60% but the specificity has not been assessed. There are no studies allowing a strict comparison of the diagnostic value of pharmacological provocation with different drugs. Based on the similarities of the electrophysiological effects on the His-Purkinje system of the above Class I agents, it is reasonable to assume that all of them might be of diagnostic value in the present clinical context, provided atrial and ventricular stimulation after drug is included in the protocol.
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ecg findings with poor prognosis Bifascicular Block as a warning sign in cases of syncope
Läkartidningen, 1997Co-Authors: A Englund, Lennart Bergfeldt, Mårten RosenqvistAbstract:Of 517 emergency room admissions for syncope at four Stockholm hospitals, 36 (7 per cent) were found to be cases of Bifascicular Block. Of these 36 patients, 34 underwent ambulatory electrocardiography (ECG) in hospital, which showed significant arrhythmia to be present in three cases [high-grade atrioventricular Block (n = 2), or sustained ventricular tachycardia (n = 1)]. After a mean follow-up of 32 months, eight more patients had developed high-grade atrioventricular Block, and 13 patients had died (eight of them suddenly). It is concluded that patients with bisfascicular Block constitute a high-risk category, and would benefit from thorough investigation, including an invasive electrophysiological study, in order to identify those at risk of progression to high-grade atrioventricular Block or malignant ventricular arrhythmia.
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disopyramide stress test a sensitive and specific tool for predicting impending high degree atrioventricular Block in patients with Bifascicular Block
Heart, 1995Co-Authors: Anders Englund, Lennart Bergfeldt, Mårten RosenqvistAbstract:OBJECTIVE--To study the value of intravenous disopyramide as part of an invasive electrophysiological study in predicting impending high degree atrioventricular Block in patients with Bifascicular Block. DESIGN--An invasive electrophysiological study was performed in the basal state and after the infusion of disopyramide (2 mg/kg body weight). The progression to high degree atrioventricular Block was assessed by bradycardia-detecting pacemakers or repeated 12-lead electrocardiogram recordings, or both. PATIENTS--73 patients with Bifascicular Block were included, of whom 25 had a history of unexplained syncope. The remaining 48 patients had no arrhythmia related symptoms and were included as controls. All patients had an ejection fraction of > 35%. RESULTS--After a mean follow up of 23 months, seven patients in the syncope group and three in the non-syncope group had a documented high degree atrioventricular Block or pacemaker-detected bradycardia of or = 6 s. The sensitivity of the disopyramide test was 71% and the specificity 98%. The corresponding figures for an abnormal electrophysiological study in the basal state were 14% and 91%, respectively. CONCLUSIONS--The sensitivity of an invasive electrophysiological study in patients with Bifascicular Block and syncope can be markedly increased by the use of intravenous disopyramide. A positive test is a highly specific finding and warrants pacemaker implantation.
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diagnostic value of programmed ventricular stimulation in patients with Bifascicular Block a prospective study of patients with and without syncope
Journal of the American College of Cardiology, 1995Co-Authors: A Englund, Lennart Bergfeldt, Nina Rehnqvist, Hans Astrom, Mårten RosenqvistAbstract: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.
Anders Englund - One of the best experts on this subject based on the ideXlab platform.
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time relation between a syncopal event and documentation of atrioventricular Block in patients with Bifascicular Block clinical implications
The Cardiology, 2007Co-Authors: Fariborz Tabrizi, Lennart Bergfeldt, Mårten Rosenqvist, Anders EnglundAbstract:Background: Transient high-degree atrioventricular (AV) Block is a common cause of syncope in patients with Bifascicular Block (BFB) but the intermittent nature of AV Block makes EC
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long term prognosis in patients with Bifascicular Block the predictive value of noninvasive and invasive assessment
Journal of Internal Medicine, 2006Co-Authors: Fariborz Tabrizi, Lennart Bergfeldt, M Rosenqvist, Anders EnglundAbstract:. Objectives. Patients with Bifascicular Block (BFB) have a high mortality rate. The purpose of the present study was to identify high-risk patients in a BFB population by performing an extensive cardiac evaluation including noninvasive and invasive tests. Design. Population-based study. Subjects. A total of 100 patients with BFB, of whom 41 had a history of unexplained syncope, were prospectively studied. The mean age was 68 ± 12. All patients were investigated with Holter-monitoring, an exercise test, an echocardiography, and an invasive electrophysiological study. The severity of congestive heart failure (CHF) was assessed by New York Heart Association (NYHA) classification. Patients in NYHA class IV were excluded. Interventions. Patients with syncope were recommended prophylactic pacemaker treatment, which was accepted by 31 patients (76%). Main outcome measures. All-cause mortality and sudden cardiac death (SCD). Results. During a median follow-up of 84 months, 33 patients died, of whom 14 in SCD. In a univariate analysis, high age, a previous myocardial infarction, and CHF were associated with a significantly increased risk of all-cause mortality and SCD. In a Cox multiple regression analysis, CHF was the only independent predictor of all-cause mortality and SCD (P < 0.01). Conclusion. Patients with BFB have a poor long-term prognosis. The predictive value of noninvasive and invasive investigations is limited. The only independent predictor of all-cause mortality and SCD in this population was the presence of CHF.
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Head-up Tilt Test A Nonspecific Method of Evaluating Patients With Bifascicular Block
Circulation, 1997Co-Authors: Anders Englund, Mia Fredrikson, Ma˚rten RosenqvistAbstract:Background Patients with Bifascicular Block have an increased risk of syncopal attacks, but the underlying mechanism often remains unclear despite an extensive diagnostic workup. The head-up tilt test has been established as an important diagnostic tool in the unmasking of vasovagal syncope in patients with unexplained syncope. Its role in the evaluation of patients with Bifascicular Block has not been studied. Methods and Results A head-up tilt test, using a 60° angle of tilt for 45 minutes without pharmacological provocation, was performed in 25 patients with Bifascicular Block and syncope that remained unexplained after an extensive invasive and noninvasive electrophysiological investigation. As a control group, 25 subjects with Bifascicular Block without syncope, matched for age, sex, left ventricular function, and underlying heart disease, were included. A positive head-up tilt test was found in 7 (28%) of the syncope patients and in 8 (32%) of the control subjects (P=NS). Six patients, of whom 3 had...
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the rr index test for the differentiation of atrioventricular nodal Block from his purkinje Block during incremental atrial pacing in patients with Bifascicular Block
European Heart Journal, 1997Co-Authors: Anders EnglundAbstract:The RR-index test for the differentiation between atrioventricular nodal from His-Purkinje Block during incremental atrial pacing in patients with Bifascicular Block.
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disopyramide stress test a sensitive and specific tool for predicting impending high degree atrioventricular Block in patients with Bifascicular Block
Heart, 1995Co-Authors: Anders Englund, Lennart Bergfeldt, Mårten RosenqvistAbstract:OBJECTIVE--To study the value of intravenous disopyramide as part of an invasive electrophysiological study in predicting impending high degree atrioventricular Block in patients with Bifascicular Block. DESIGN--An invasive electrophysiological study was performed in the basal state and after the infusion of disopyramide (2 mg/kg body weight). The progression to high degree atrioventricular Block was assessed by bradycardia-detecting pacemakers or repeated 12-lead electrocardiogram recordings, or both. PATIENTS--73 patients with Bifascicular Block were included, of whom 25 had a history of unexplained syncope. The remaining 48 patients had no arrhythmia related symptoms and were included as controls. All patients had an ejection fraction of > 35%. RESULTS--After a mean follow up of 23 months, seven patients in the syncope group and three in the non-syncope group had a documented high degree atrioventricular Block or pacemaker-detected bradycardia of or = 6 s. The sensitivity of the disopyramide test was 71% and the specificity 98%. The corresponding figures for an abnormal electrophysiological study in the basal state were 14% and 91%, respectively. CONCLUSIONS--The sensitivity of an invasive electrophysiological study in patients with Bifascicular Block and syncope can be markedly increased by the use of intravenous disopyramide. A positive test is a highly specific finding and warrants pacemaker implantation.
Lennart Bergfeldt - One of the best experts on this subject based on the ideXlab platform.
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time relation between a syncopal event and documentation of atrioventricular Block in patients with Bifascicular Block clinical implications
The Cardiology, 2007Co-Authors: Fariborz Tabrizi, Lennart Bergfeldt, Mårten Rosenqvist, Anders EnglundAbstract:Background: Transient high-degree atrioventricular (AV) Block is a common cause of syncope in patients with Bifascicular Block (BFB) but the intermittent nature of AV Block makes EC
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long term prognosis in patients with Bifascicular Block the predictive value of noninvasive and invasive assessment
Journal of Internal Medicine, 2006Co-Authors: Fariborz Tabrizi, Lennart Bergfeldt, M Rosenqvist, Anders EnglundAbstract:. Objectives. Patients with Bifascicular Block (BFB) have a high mortality rate. The purpose of the present study was to identify high-risk patients in a BFB population by performing an extensive cardiac evaluation including noninvasive and invasive tests. Design. Population-based study. Subjects. A total of 100 patients with BFB, of whom 41 had a history of unexplained syncope, were prospectively studied. The mean age was 68 ± 12. All patients were investigated with Holter-monitoring, an exercise test, an echocardiography, and an invasive electrophysiological study. The severity of congestive heart failure (CHF) was assessed by New York Heart Association (NYHA) classification. Patients in NYHA class IV were excluded. Interventions. Patients with syncope were recommended prophylactic pacemaker treatment, which was accepted by 31 patients (76%). Main outcome measures. All-cause mortality and sudden cardiac death (SCD). Results. During a median follow-up of 84 months, 33 patients died, of whom 14 in SCD. In a univariate analysis, high age, a previous myocardial infarction, and CHF were associated with a significantly increased risk of all-cause mortality and SCD. In a Cox multiple regression analysis, CHF was the only independent predictor of all-cause mortality and SCD (P < 0.01). Conclusion. Patients with BFB have a poor long-term prognosis. The predictive value of noninvasive and invasive investigations is limited. The only independent predictor of all-cause mortality and SCD in this population was the presence of CHF.
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Pharmacological stress testing of the His-Purkinje system in patients with Bifascicular Block.
Pacing and Clinical Electrophysiology, 1998Co-Authors: Anders Enclund, Lennart Bergfeldt, Mårten RosenqvistAbstract:: This literature review, based mainly on the English-language literature, focuses on pharmacological stress testing of the His-Purkinje system as part of an invasive electrophysiological study. The main target group for this investigation is patients with Bifascicular Block and syncope in which intermittent high grade AV Block is suspected. Several drugs have been used for this purpose, mainly Class I antiarrhythmic agents such as ajmaline, procainamide, disopyramide, and flecainide. Most studies, unfortunately, suffer from limited patient numbers, lack of adequate control groups, and/or adequate follow-up. The sensitivity of the disopyramide stress test has been shown to be 75%-100% for prediction of impending high grade AV Block. The specificity was > 90%. Studies on procainamide have shown a sensitivity of 60% but the specificity has not been assessed. There are no studies allowing a strict comparison of the diagnostic value of pharmacological provocation with different drugs. Based on the similarities of the electrophysiological effects on the His-Purkinje system of the above Class I agents, it is reasonable to assume that all of them might be of diagnostic value in the present clinical context, provided atrial and ventricular stimulation after drug is included in the protocol.
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ecg findings with poor prognosis Bifascicular Block as a warning sign in cases of syncope
Läkartidningen, 1997Co-Authors: A Englund, Lennart Bergfeldt, Mårten RosenqvistAbstract:Of 517 emergency room admissions for syncope at four Stockholm hospitals, 36 (7 per cent) were found to be cases of Bifascicular Block. Of these 36 patients, 34 underwent ambulatory electrocardiography (ECG) in hospital, which showed significant arrhythmia to be present in three cases [high-grade atrioventricular Block (n = 2), or sustained ventricular tachycardia (n = 1)]. After a mean follow-up of 32 months, eight more patients had developed high-grade atrioventricular Block, and 13 patients had died (eight of them suddenly). It is concluded that patients with bisfascicular Block constitute a high-risk category, and would benefit from thorough investigation, including an invasive electrophysiological study, in order to identify those at risk of progression to high-grade atrioventricular Block or malignant ventricular arrhythmia.
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disopyramide stress test a sensitive and specific tool for predicting impending high degree atrioventricular Block in patients with Bifascicular Block
Heart, 1995Co-Authors: Anders Englund, Lennart Bergfeldt, Mårten RosenqvistAbstract:OBJECTIVE--To study the value of intravenous disopyramide as part of an invasive electrophysiological study in predicting impending high degree atrioventricular Block in patients with Bifascicular Block. DESIGN--An invasive electrophysiological study was performed in the basal state and after the infusion of disopyramide (2 mg/kg body weight). The progression to high degree atrioventricular Block was assessed by bradycardia-detecting pacemakers or repeated 12-lead electrocardiogram recordings, or both. PATIENTS--73 patients with Bifascicular Block were included, of whom 25 had a history of unexplained syncope. The remaining 48 patients had no arrhythmia related symptoms and were included as controls. All patients had an ejection fraction of > 35%. RESULTS--After a mean follow up of 23 months, seven patients in the syncope group and three in the non-syncope group had a documented high degree atrioventricular Block or pacemaker-detected bradycardia of or = 6 s. The sensitivity of the disopyramide test was 71% and the specificity 98%. The corresponding figures for an abnormal electrophysiological study in the basal state were 14% and 91%, respectively. CONCLUSIONS--The sensitivity of an invasive electrophysiological study in patients with Bifascicular Block and syncope can be markedly increased by the use of intravenous disopyramide. A positive test is a highly specific finding and warrants pacemaker implantation.
W Schutz - One of the best experts on this subject based on the ideXlab platform.
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perioperative transcutaneous pacemaker in patients with chronic Bifascicular Block or left bundle branch Block and additional first degree atrioventricular Block
Acta Anaesthesiologica Scandinavica, 1999Co-Authors: Albrecht Gauss, C Hubner, Rainer Meierhenrich, H J Rohm, M Georgieff, W SchutzAbstract:Background: Complete heart Block is dreaded perioperatively in patients with chronic Bifascicular or left bundle branch Block (LBBB) and additional first-degree A-V Block. Our aim was to investigate the necessity as well as the efficacy and safety of transcutaneous pacing in the perioperative setting. Methods: Thirty-nine consecutive patients with asymptomatic chronic Bifascicular Block or LBBB and prolongation of the P-R interval scheduled to undergo surgery under anesthesia were prospectively enrolled in the study. Preoperatively, a transcutaneous pacemaker (PACE 500 D, Osypka Co.) was applied; its efficacy was checked with intra-arterial blood pressure measurement; the pain level was recorded. Additionally, 24-h Holter monitoring (CM2, CM5) was applied. Occurrences of a Block progression or a bradycardia of <40 beats/min with hemodynamic impairment were the defined end points. Results: Thirty-seven of the 39 patients (95%) could be successfully stimulated with a median current strength of 70 mA; whereby 33 of the 39 patients felt moderate to severe pain. There was no perioperative Block progression. Three cases of bradycardia of <40 beats/min with a critical drop in blood pressure occurred; but these patients were successfully treated with drug therapy without pacemaker stimulation. Conclusion: The perioperative application and testing of the pacemaker was safe and could be performed in nearly all patients successfully. However, we do not consider a routine prophylactic transcutaneous placement in patients with chronic Bifascicular or LBBB and additional first-degree A-V Block justified. Nevertheless, appropriate drugs and temporary pacemaker equipment should be easily accessible.
Harilaos Bogossian - One of the best experts on this subject based on the ideXlab platform.
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qtc interval evaluation in patients with right bundle branch Block or Bifascicular Blocks
Clinical Cardiology, 2020Co-Authors: Damir Erkapic, Gerrit Frommeyer, Niklas Brettner, Korkut Sozener, Harry J G M Crijns, Melchior Seyfarth, Christian W Hamm, Harilaos BogossianAbstract:BACKGROUND The right bundle branch Block (RBBB) and the Bifascicular Blocks affect QRS duration in the right precordial leads, which are usually used for QT interval determination. Up to now, there is no clear recommendation how to determine QT interval in patients with RBBB or Bifascicular Block. HYPOTHESIS The hypothesis of the present study was to evaluate the feasibility of a simple formula for RBBB and Bifascicular Block correction, thereby making it easier to determine the QTc interval. METHODS In patients with intrinsic QRS duration <120 ms, artificial RBBB with either left posterior (LPFB) or left anterior fascicular Block (LAFB), created by left ventricular pacing maneuvers, were corrected using the Bogossian formula (QTm) and afterward were heart rate corrected (QTmc). Heart rate correction was performed using different heart rate formulas in comparison to each other. The QTmc intervals were compared in each patient with the QTc interval during intrinsic rhythm. RESULTS A total of scheduled 71 patients were included in this prospective multicenter observational comparative study. Compared to intrinsic QTc interval, the mean ΔQTmc interval by combination of the Bogossian and the Hodge formulas was -3 ± 24 ms in RBBB + LPFB (P = .44) and -6 ± 25 ms in RBBB + LAFB (P = .15). The Bogossian formula showed a significant deviation from the actual QTc interval with both the Bazett and the Fridericia formulas. CONCLUSION In combination with the Hodge formula, the Boggosian formula delivered the best results in comparing the true QTc interval in narrow QRS with the QTmc interval in the presence of a Bifascicular Block.