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[Usefulness of the electrophysiologic study in the prognostic evaluation of patients with syncope of uncertain origin].

AbstractUNLABELLED:
Recurrent, sudden temporary loss of consciousness is a common clinical problem: in the absence of electrocardiographic monitoring during a syncopal episode (S), abnormalities demonstrated by an electrophysiological study (ES) may suggest the etiology of S. We have performed a complete ES in 53 Pts (M. 38-F. 15, mean age 63 y.) with recurrent unexplained S (3.8 S/pt) by means of a standardized protocol. Group I: 30 Pts (mean age 65 y, 3.6 S/pt) with structural heart disease. Thirteen of these had abnormal ES findings: inducible ventricular tachycardia in 6, prolonged HV interval in 7 (with bundle branch block), very fast atrial flutter in one. Group II: 23 Pts (mean age 61 y., 3, 9 S/pt), without organic heart disease. The ES was abnormal in 14 Pts showing a prolonged HV interval in 11 (with bundle branch block), an intrahisian block in 1 and an inducible AV nodal tachycardia with heart rate greater than 200/m' in one. Only the Pts with abnormal ES were treated according to their condition with amiodarone or with an implantable pacemaker. Three PTs with C.H.D. and normal ES successfully underwent by-pass surgery. During the follow-up (20 months) therapy based on ES provided symptomatic relief (no S) in 25 of 26 Pts with abnormal electrophysiological study. Syncope persisted in 4 of 26 Pts in whom ES did not define a mechanism of S. No sudden death in any Pt.
CONCLUSIONS:
ES was, therefore, of diagnostic value in more than half of the patients with syncope of unknown cause and long-term treatment based on ES was successful in the prevention of S (remission rate of 93% in patients treated with amiodarone or pacemaker).
AuthorsA Proclemer, P Gianfagna, A Fontanelli, G Bernardi, G A Feruglio
JournalGiornale italiano di cardiologia (G Ital Cardiol) Vol. 17 Issue 5 Pg. 402-13 (May 1987) ISSN: 0046-5968 [Print] Italy
Vernacular TitleUtilità dello studio elettrofisiologico nella valutazione prognostica dei pazienti con sincopi di incerta origine.
PMID3653598 (Publication Type: English Abstract, Journal Article)
Chemical References
  • Amiodarone
Topics
  • Adult
  • Aged
  • Aged, 80 and over
  • Amiodarone (therapeutic use)
  • Arrhythmias, Cardiac (complications, diagnosis, physiopathology, therapy)
  • Electrocardiography
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Pacemaker, Artificial
  • Syncope (etiology, physiopathology)

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