Search tips
Search criteria 


Logo of brheartjLink to Publisher's site
Br Heart J. 1995 December; 74(6): 650–655.
PMCID: PMC484123

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. 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 = 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.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.0M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Schneider JF, Thomas HE, Kreger BE, McNamara PM, Sorlie P, Kannel WB. Newly acquired right bundle-branch block: The Framingham Study. Ann Intern Med. 1980 Jan;92(1):37–44. [PubMed]
  • Schneider JF, Thomas HE, Jr, Kreger BE, McNamara PM, Kannel WB. Newly acquired left bundle-branch block: the Framingham study. Ann Intern Med. 1979 Mar;90(3):303–310. [PubMed]
  • McAnulty JH, Rahimtoola SH. Bundle branch block. Prog Cardiovasc Dis. 1984 Jan-Feb;26(4):333–354. [PubMed]
  • Dhingra RC, Palileo E, Strasberg B, Swiryn S, Bauernfeind RA, Wyndham CR, Rosen KM. Significance of the HV interval in 517 patients with chronic bifascicular block. Circulation. 1981 Dec;64(6):1265–1271. [PubMed]
  • Scheinman MM, Peters RW, Suavé MJ, Desai J, Abbott JA, Cogan J, Wohl B, Williams K. Value of the H-Q interval in patients with bundle branch block and the role of prophylactic permanent pacing. Am J Cardiol. 1982 Dec;50(6):1316–1322. [PubMed]
  • McAnulty JH, Rahimtoola SH, Murphy E, DeMots H, Ritzmann L, Kanarek PE, Kauffman S. Natural history of "high-risk" bundle-branch block: final report of a prospective study. N Engl J Med. 1982 Jul 15;307(3):137–143. [PubMed]
  • Scheinman MM, Peters RW, Morady F, Sauvé MJ, Malone P, Modin G. Electrophysiologic studies in patients with bundle branch block. Pacing Clin Electrophysiol. 1983 Sep;6(5 Pt 2):1157–1165. [PubMed]
  • Dhingra RC, Wyndham C, Bauernfeind R, Swiryn S, Deedwania PC, Smith T, Denes P, Rosen KM. Significance of block distal to the His bundle induced by atrial pacing in patients with chronic bifascicular block. Circulation. 1979 Dec;60(7):1455–1464. [PubMed]
  • Poupet JY, Allal J, Vieyres C, Gallimard JF, Coisne D, Barraine R. Evolution à 5 ans des blocs de branches chroniques chez 164 patients appareillés par stimulateur sans bloc auriculo-ventriculaire spontané documenté. Etude des critères prédictifs. Arch Mal Coeur Vaiss. 1989 Apr;82(4):533–540. [PubMed]
  • Kaul U, Dev V, Narula J, Malhotra AK, Talwar KK, Bhatia ML. Evaluation of patients with bundle branch block and "unexplained" syncope: a study based on comprehensive electrophysiologic testing and ajmaline stress. Pacing Clin Electrophysiol. 1988 Mar;11(3):289–297. [PubMed]
  • Twidale N, Heddle WF, Tonkin AM. Procainamide administration during electrophysiology study--utility as a provocative test for intermittent atrioventricular block. Pacing Clin Electrophysiol. 1988 Oct;11(10):1388–1397. [PubMed]
  • Click RL, Gersh BJ, Sugrue DD, Holmes DR, Jr, Wood DL, Osborn MJ, Hammill SC. Role of invasive electrophysiologic testing in patients with symptomatic bundle branch block. Am J Cardiol. 1987 Apr 1;59(8):817–823. [PubMed]
  • Ezri M, Lerman BB, Marchlinski FE, Buxton AE, Josephson ME. Electrophysiologic evaluation of syncope in patients with bifascicular block. Am Heart J. 1983 Oct;106(4 Pt 1):693–697. [PubMed]
  • Bergfeldt L, Rosenqvist M, Vallin H, Edhag O. Disopyramide induced second and third degree atrioventricular block in patients with bifascicular block. An acute stress test to predict atrioventricular block progression. Br Heart J. 1985 Mar;53(3):328–334. [PMC free article] [PubMed]
  • Vogt A, von Essen R, Tebbe U, Feuerer W, Appel KF, Niederer W, Neuhaus KL. Frequency of achieving optimal reperfusion with thrombolysis in acute myocardial infarction (analysis of four German multicenter studies). Am J Cardiol. 1994 Jul 1;74(1):1–4. [PubMed]
  • Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, Gutgesell H, Reichek N, Sahn D, Schnittger I, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr. 1989 Sep-Oct;2(5):358–367. [PubMed]
  • Rosenqvist M, Edhag KO, Vallin HO. Clinical experience with a bradycardia indicating pacemaker. Pacing Clin Electrophysiol. 1983 May;6(3 Pt 1):515–524. [PubMed]
  • Guidelines for clinical intracardiac electrophysiologic studies. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Subcommittee to Assess Clinical Intracardiac Electrophysiologic Studies). J Am Coll Cardiol. 1989 Dec;14(7):1827–1842. [PubMed]
  • Morady F, Higgins J, Peters RW, Schwartz AB, Shen EN, Bhandari A, Scheinman MM, Sauvé MJ. Electrophysiologic testing in bundle branch block and unexplained syncope. Am J Cardiol. 1984 Sep 1;54(6):587–591. [PubMed]

Articles from British Heart Journal are provided here courtesy of BMJ Group