{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T23:28:21Z","timestamp":1774740501996,"version":"3.50.1"},"reference-count":13,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2022,2,28]],"date-time":"2022-02-28T00:00:00Z","timestamp":1646006400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>The presence of bifascicular block on electrocardiography suggests that otherwise-unexplained syncope may be due to complete heart block. European Society of Cardiology (ESC) recommends investigating it with electrophysiology study (EPS). PPM is indicated if high-degree atrioventricular block is inducible. Long term rhythm monitoring with implantable loop recorder (ILR) is recommended if EPS is negative. We evaluated adherence to these guidelines.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This is a single-center retrospective audit of adult patients with bifascicular block hospitalized for unexplained syncope between January 2018 and August 2019 under general medicine service. Patients with an alternative explanation for syncope were excluded. Guideline adherence was assessed by formal cardiology consult and whether EPS followed by ILR and\/or PPM were offered.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>65 out of 580 adult patients (11.2%) admitted to general medicine service for syncope had a bifascicular block; 29 (5%) were identified to have bifascicular block and unexplained syncope. Median age was 77 \u00b110 years; 9 (31%) were female, and 6 (20.7%) patients had at least one prior hospital visit for syncope at our academic medical center. Cardiology was consulted on 17 (58.6%) patients. Two patients were evaluated by EPS (1 refused) followed by ILR. Overall, 3 out of 29 patients (10.3%) received guideline-directed evaluation during the hospitalization based on ESC guidelines. None of the patients received empiric PPM during the index hospitalization.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Among patients admitted to the general medicine service with unexplained syncope and bifascicular block, a minority (10.3%) underwent guideline-directed evaluation per ESC recommendations. Cardiology was consulted in 58.6% of cases.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0263727","type":"journal-article","created":{"date-parts":[[2022,2,28]],"date-time":"2022-02-28T18:30:25Z","timestamp":1646073025000},"page":"e0263727","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Bifascicular block in unexplained syncope is underrecognized and under-evaluated: A single-center audit of ESC guidelines adherence"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8275-3847","authenticated-orcid":true,"given":"Muhammad Asim","family":"Shabbir","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad Hamza","family":"Saad Shaukat","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moiz","family":"Ehtesham","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shannon","family":"Murawski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sukhraj","family":"Singh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rizwan","family":"Alimohammad","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2022,2,28]]},"reference":[{"issue":"17","key":"pone.0263727.ref001","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":"M. Brignole","year":"2001","journal-title":"Circulation"},{"issue":"21","key":"pone.0263727.ref002","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":"M. Brignole","year":"2018","journal-title":"European Heart Journal"},{"key":"pone.0263727.ref003","unstructured":"RACTrac survey: Exploring the impact of the RAC program on hospitals nationwide | AHA. (n.d.). Retrieved from https:\/\/www.aha.org\/guidesreports\/2012-02-15-ractrac-survey-exploring-impact-rac-program-hospitals-nationwide"},{"issue":"2","key":"pone.0263727.ref004","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/j.annemergmed.2013.10.029","article-title":"Randomized clinical trial of an emergency department observation syncope protocol versus routine inpatient admission","volume":"64","author":"B.C. Sun","year":"2014","journal-title":"Ann Emerg Med"},{"issue":"5","key":"pone.0263727.ref005","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1016\/j.mcna.2016.04.010","article-title":"The Cost-Effective Evaluation of Syncope","volume":"100","author":"S. Angus","year":"2016","journal-title":"Med Clin North Am"},{"issue":"2","key":"pone.0263727.ref006","first-page":"1","article-title":"Is our initial evaluation of patients admitted for syncope guideline-directed and cost-effective? European heart journal","volume":"4","author":"M.H. Saad Shaukat","year":"2020","journal-title":"Case reports"},{"issue":"5","key":"pone.0263727.ref007","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1016\/j.amjcard.2004.11.013","article-title":"Direct medical costs of syncope-related hospitalizations in the United States","volume":"95","author":"B.C. Sun","year":"2005","journal-title":"Am J Cardiol"},{"issue":"5","key":"pone.0263727.ref008","first-page":"e60","article-title":"2017 ACC\/AHA\/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society","volume":"136","author":"W.K. Shen","year":"2017","journal-title":"Circulation"},{"issue":"19","key":"pone.0263727.ref009","doi-asserted-by":"crossref","first-page":"2410","DOI":"10.1016\/j.jacc.2019.09.012","article-title":"Acc\/aha\/hrs versus esc guidelines for the diagnosis and management of syncope: jacc guideline comparison","volume":"74","author":"ZD Goldberger","year":"2019","journal-title":"J Am Coll Cardiol"},{"issue":"3","key":"pone.0263727.ref010","doi-asserted-by":"crossref","first-page":"302","DOI":"10.7326\/0003-4819-81-3-302","article-title":"Syncope in patients with chronic bifascicular block. Significance, causative mechanisms, and clinical implications","volume":"81","author":"R.C. Dhingra","year":"1974","journal-title":"Ann Intern Med"},{"issue":"3","key":"pone.0263727.ref011","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1056\/NEJM198207153070301","article-title":"Natural history of \"high-risk\" bundle-branch block: final report of a prospective study","volume":"307","author":"J.H. McAnulty","year":"1982","journal-title":"N Engl J Med"},{"issue":"7","key":"pone.0263727.ref012","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.1093\/europace\/eus005","article-title":"Empiric pacemaker compared with a monitoring strategy in patients with syncope and bifascicular conduction block\u2014rationale and design of the Syncope: Pacing or Recording in ThE Later Years (SPRITELY) study","volume":"14","author":"A.D. Krahn","year":"2012","journal-title":"Europace"},{"issue":"1","key":"pone.0263727.ref013","first-page":"101","article-title":"Prevention of Syncope Through Permanent Cardiac Pacing in Patients With Bifascicular Block and Syncope of Unexplained Origin","volume":"6","author":"M. Santini","year":"2013","journal-title":"Circulation: Arrhythmia and Electrophysiology"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0263727","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,2,28]],"date-time":"2022-02-28T18:30:37Z","timestamp":1646073037000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0263727"}},"subtitle":[],"editor":[{"given":"Tauseef","family":"Akhtar","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2022,2,28]]},"references-count":13,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,2,28]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0263727","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,28]]}}}