Disopyramide stress test: a sensitive and specific tool for predicting impending high degree atrioventricular block in patients with bifascicular block.
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.


METHODS
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.


METHODS
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 = 30 beats/min for > 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.
Department of Cardiology, Karolinska Hospital, Stockholm, Sweden.
A
A
Englund
L
L
Bergfeldt
M
M
Rosenqvist
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004206:Disopyramide; D004562:Electrocardiography; D004594:Electrophysiology; D005260:Female; D006327:Heart Block / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity
D004206:Disopyramide