{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T04:08:24Z","timestamp":1788754104107,"version":"build-2803163510"},"reference-count":12,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T00:00:00Z","timestamp":1788652800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T00:00:00Z","timestamp":1788652800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pacing Clinical Electrophis"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The long\u2011term need for permanent pacemaker (PM) implantation in patients with syncope, bundle branch block (BBB), and a negative electrophysiological study (EPS) is not well defined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p>\n                      We retrospectively analyzed consecutive patients undergoing EPS for syncope and any type of BBB between May 2012 and December 2023 at our Institution. Only individuals with a negative EPS and no pre\u2011existing indication for pacing were included. The primary endpoint was PM implantation during follow\u2011up. Eighty\u2010nine patients with a negative EPS were included (median age 80 years; 63% male). An implantable loop recorder (ILR) was used in 57 patients (64%). At the time of EPS, 36 patients (40%) reported a single lifetime syncope, whereas 53 (60%) had multiple episodes (\u22652). Over a median follow\u2010up of 29.5 months, 33 patients (37%) underwent PM implantation, with cumulative rates of 28%, 32%, and 35% at 1, 2, and 3 years, respectively, reaching 46% at 7 years. On multivariate analysis, a history of multiple syncope (hazard ratio 2.39, 95% CI 1.03\u20135.53,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.042) and ILR use (hazard ratio 2.44, 95% CI 1.04\u20135.73,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.040) independently predicted PM implantation, while baseline conduction abnormalities and HV interval did not.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our findings highlighted the limited negative predictive value of EPS in patients with syncope and BBB. During extended follow\u2010up, PM implantation is frequent and found to be associated with a clinical history of recurrent syncope and the use of ILR.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/pace.70425","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T03:33:23Z","timestamp":1788752003000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pacemaker Implantation in Patients With Syncope, Bundle Branch Block and Negative Electrophysiological Study"],"prefix":"10.1111","author":[{"given":"Matteo","family":"Iori","sequence":"first","affiliation":[{"name":"Cardiology Department AUSL IRCCS Reggio Emilia  Reggio Emilia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Giacopelli","sequence":"additional","affiliation":[{"name":"Clinical Research Biotronik Italia S.p.a Cologno Monzese (MI) Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Battista","sequence":"additional","affiliation":[{"name":"Cardiology Department AUSL IRCCS Reggio Emilia  Reggio Emilia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Biagi","sequence":"additional","affiliation":[{"name":"Cardiology Department AUSL IRCCS Reggio Emilia  Reggio Emilia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro Cesare Mario","family":"Ceresoli","sequence":"additional","affiliation":[{"name":"Cardiology Department AUSL IRCCS Reggio Emilia  Reggio Emilia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Sciarroni","sequence":"additional","affiliation":[{"name":"Cardiology Department University of Medicine Parma  Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Brignole","sequence":"additional","affiliation":[{"name":"Cardiology Department IRCCS Istituto Auxologico Italiano Ospedale San Luca  Milano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Navazio","sequence":"additional","affiliation":[{"name":"Cardiology Department AUSL IRCCS Reggio Emilia  Reggio Emilia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Quartieri","sequence":"additional","affiliation":[{"name":"Cardiology Department AUSL IRCCS Reggio Emilia  Reggio Emilia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Bottoni","sequence":"additional","affiliation":[{"name":"Cardiology Department AUSL IRCCS Reggio Emilia  Reggio Emilia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,6]]},"reference":[{"key":"e_1_2_11_2_1","first-page":"768","article-title":"Electrophysiologic Study of Atrio\u2010Ventricular Block and Ventricular Conduction Defects","volume":"14","author":"Gronda M.","year":"1984","journal-title":"Giornale Italiano Di Cardiologia"},{"key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"2045","DOI":"10.1161\/hc4201.097837","article-title":"Mechanism of Syncope in Patients With Bundle Branch Block and Negative Electrophysiological Test","volume":"104","author":"Brignole M.","year":"2001","journal-title":"Circulation"},{"key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1016\/j.acvd.2012.12.002","article-title":"Clinical Impact of the Implantable Loop Recorder in Patients With Isolated Syncope, Bundle Branch Block and Negative Workup: A Randomized Multicentre Prospective Study","volume":"106","author":"Defaye P.","year":"2013","journal-title":"Archives of Cardiovascular Diseases"},{"key":"e_1_2_11_5_1","first-page":"101","article-title":"Prevention of Syncope Through Permanent Cardiac Pacing in Patients With Bifascicular Block and Syncope of Unexplained Origin: The PRESS Study","volume":"6","author":"Santini M.","year":"2013","journal-title":"Circulation: Arrhythmia and Electrophysiology"},{"key":"e_1_2_11_6_1","doi-asserted-by":"crossref","first-page":"1567","DOI":"10.1111\/jgs.14225","article-title":"Etiology of Syncope and Unexplained Falls in Elderly Adults With Dementia: Syncope Ed Dementia (SYD) Study","volume":"64","author":"Ungar A.","year":"2016","journal-title":"Journal of the American Geriatrics Society"},{"key":"e_1_2_11_7_1","doi-asserted-by":"crossref","first-page":"1310","DOI":"10.1016\/j.hrthm.2021.04.010","article-title":"Electrophysiology Studies for Predicting Atrioventricular Block in Patients With Syncope: A Systematic Review and Metaanalysis","volume":"18","author":"Sheldon R. S.","year":"2021","journal-title":"Heart Rhythm"},{"key":"e_1_2_11_8_1","doi-asserted-by":"crossref","first-page":"1883","DOI":"10.1093\/eurheartj\/ehy037","article-title":"2018 ESC Guidelines for the Diagnosis and Management of Syncope","volume":"39","author":"Brignole M.","year":"2018","journal-title":"European Heart Journal"},{"key":"e_1_2_11_9_1","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1016\/j.hrthm.2018.12.015","article-title":"Syncope, Conduction Disturbance, and Negative Electrophysiological Test: Predictive Factors and Risk Score to Predict Pacemaker Implantation During Follow\u2010up","volume":"16","author":"Roca\u2010Luque I.","year":"2019","journal-title":"Heart Rhythm"},{"key":"e_1_2_11_10_1","first-page":"239","article-title":"Randomized Pragmatic Trial of Pacemaker versus Implantable Cardiac Monitor in Syncope and Bifascicular Block","volume":"8","author":"Sheldon R.","year":"2022","journal-title":"Journal of the American College of Cardiology: Clinical Electrophysiology"},{"key":"e_1_2_11_11_1","doi-asserted-by":"crossref","first-page":"1696","DOI":"10.1016\/j.hrthm.2022.05.023","article-title":"Management of Older Patients With Unexplained, Recurrent, Traumatic Syncope and Bifascicular Block: Implantable Loop Recorder Versus Empiric Pacemaker Implantation\u2014Results of a Propensity\u2010Matched Analysis","volume":"19","author":"Palmisano P.","year":"2022","journal-title":"Heart Rhythm"},{"key":"e_1_2_11_12_1","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.1111\/pace.12946","article-title":"Long\u2010Term Outcome of Patients With Bifascicular Block and Unexplained Syncope Following Cardiac Pacing","volume":"39","author":"Kalscheur M.","year":"2016","journal-title":"PACE"},{"key":"e_1_2_11_13_1","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1093\/europace\/euab232","article-title":"2021 ESC Guidelines on Cardiac Pacing and Cardiac Resynchronization Therapy","volume":"24","author":"Glikson M.","year":"2022","journal-title":"Europace"}],"container-title":["Pacing and Clinical Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70425","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/pace.70425","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70425","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T03:33:27Z","timestamp":1788752007000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pace.70425"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,6]]},"references-count":12,"alternative-id":["10.1111\/pace.70425"],"URL":"https:\/\/doi.org\/10.1111\/pace.70425","archive":["Portico"],"relation":{},"ISSN":["0147-8389","1540-8159"],"issn-type":[{"value":"0147-8389","type":"print"},{"value":"1540-8159","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,6]]},"assertion":[{"value":"2026-06-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-29","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-06","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"pace.70425"}}