Policy, Payment & Practice -> Clinical Quality Measures and Outcomes D-PO02 - Poster Session II (ID 47) Poster

D-PO02-120 - Bifascicular Block In Unexplained Syncope; Underrecognized & Underevaulated (ID 215)

 M. Shabbir: Nothing relevant to disclose.


Background: For older patients with unexplained syncope & chronic bifascicular block (BFB), ACC/HRS recommends empiric permanent pacemaker (PPM) implantation. ESC guidelines favor electrophysiologic study (EPS) and/or implanted loop recorder (ILR) to identify high degree AV block for PPM.
Objective: Guideline adherence for older patients with chronic BFB & unexplained syncope.
Methods: Single center retrospective analysis of adult patients with BFB hospitalized for syncope between Jan 2018 & Aug 2019. Patients with age<50 years, preexisting/alternate indication for PPM, orthostatic hypotension, seizure, stroke, LVEF<35%, and structural, ischemic or infiltrative cardiomyopathy were excluded. Appropriateness of evaluation was assessed by formal cardiology consult and whether EPS, ILR and/or PPM was offered. Subsequent syncope-related hospitalization or trauma was noted.
Results: 580 patients were hospitalized for syncope - 32 (5.5%) were ≥ age 50 with BFB & unexplained syncope; mean age was 74 ± 11 years, 11 were female, LBBB (n=16) and RBBB+LAFB/LPFB (n=16). Seven (21.8%) patients had at least one prior syncope-related hospitalization. Cardiology was consulted on 19 patients (59.3%). No patients received PPM during index hospitalization; 11 patients (34.3%) were evaluated appropriately. EPS was performed in 3 patients, 6 patients received ILR before discharge and 2 had both EPS and ILR. Of 8 patients with ILR, 4 (50%) received PPM within 12 months for high-degree AV block. There was no subsequent syncope-related hospitalization or trauma in appropriately evaluated group. Nine out 21 patients not evaluated with EPS or ILR had at least one subsequent syncope-related hospitalization (0% vs 42.8%, p 0.01, NNT 2.3); 5 patients suffered non fatal trauma (0% vs 23.8%, p 0.07). The total number of recurrent syncope-related hospitalizations was 13.
Conclusion: Over 20 months - 21.8% of older patients with BFB admitted for unexplained syncope had a prior syncope-related hospitalization. No patients received empiric PPM. Only one-third (34.3%) were appropriately evaluated with EPS or ILR. Patients not evaluated were more likely to have a subsequent syncope-related hospitalization. Guideline adherence may prevent syncope-related hospitalization and trauma.