Journal Article

Unexplained syncope in patients with structural heart disease and no documented ventricular arrhythmias: value of electrophysiologically guided implantablecardioverter defibrillator therapy

T. Pezawas, G. Stix, J. Kastner, M. Wolzt, C. Mayer, D. Moertl and H. Schmidinger

in EP Europace

Published on behalf of European Heart Rhythm Association of the European Society of Cardiology (ESC)

Volume 5, issue 3, pages 305-312
Published in print July 2003 | ISSN: 1099-5129
Published online July 2003 | e-ISSN: 1532-2092 | DOI: http://dx.doi.org/10.1016/S1099-5129(03)00044-8
Unexplained syncope in patients with structural heart disease and no documented ventricular arrhythmias: value of electrophysiologically guided implantablecardioverter defibrillator therapy

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Aims

To evaluate electrophysiologically guided implantable cardioverter defibrillator (ICD) therapy in patients with syncope, structural heart disease and no documented sustained ventricular tachycardia (sVT).

Methods and Results

Programmed ventricular stimulation (PVS) was performed in 52 patients (age 62±10 years): 40 patients had ischaemic and 12 patients had idiopathic dilated cardiomyopathy. On PVS sVT and ventricular fibrillation were induced in seven and four patients, respectively, and two patients spontaneously experienced symptomatic sVT. These patients received an ICD (ICD group, n=13). Non-inducible patients were left on conventional therapy (non-ICD group, n=39). During 5±2.8 years five ICD patients received therapies, all appropriate. There were seven non-sudden deaths and overall survival analysis revealed no significant difference. Recurrent syncope occurred in five ICD and four non-ICD patients and did not correlate well with sVT. The positive and negative predictive values of PVS for tachyarrhythmias or sudden death were 36 and 98%, respectively.

Conclusion

Syncope per se does not necessarily herald a bad prognosis. PVS identifies high-risk patients. Induction of ventricular fibrillation with double or triple extrastimuli is of limited value. Patients with poor left ventricular function and bad clinical condition benefit most from an ICD. Syncope and sVT are not necessarily correlated during follow-up, which may merit consideration.

Keywords: Implantable cardioverter defibrillator; unexplained syncope; electrophysiological testing

Journal Article.  3641 words.  Illustrated.

Subjects: Cardiovascular Medicine

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