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Francisco Pascual J, Jordan Marchite P, Rodríguez Silva J, Rivas Gándara N. Arrhythmic syncope: From diagnosis to management. World J Cardiol 2023; 15:119-141. [PMID: 37124975 PMCID: PMC10130893 DOI: 10.4330/wjc.v15.i4.119] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/02/2023] [Accepted: 04/10/2023] [Indexed: 04/20/2023] Open
Abstract
Syncope is a concerning symptom that affects a large proportion of patients. It can be related to a heterogeneous group of pathologies ranging from trivial causes to diseases with a high risk of sudden death. However, benign causes are the most frequent, and identifying high-risk patients with potentially severe etiologies is crucial to establish an accurate diagnosis, initiate effective therapy, and alter the prognosis. The term cardiac syncope refers to those episodes where the cause of the cerebral hypoperfusion is directly related to a cardiac disorder, while arrhythmic syncope is cardiac syncope specifically due to rhythm disorders. Indeed, arrhythmias are the most common cause of cardiac syncope. Both bradyarrhythmia and tachyarrhythmia can cause a sudden decrease in cardiac output and produce syncope. In this review, we summarized the main guidelines in the management of patients with syncope of presumed arrhythmic origin. Therefore, we presented a thorough approach to syncope work-up through different tests depending on the clinical characteristics of the patients, risk stratification, and the management of syncope in different scenarios such as structural heart disease and channelopathies.
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Affiliation(s)
- Jaume Francisco Pascual
- Unitat d’Arritmies Servei de Cardiologia VHIR, Hospital Universitari Vall d’Hebron, Barcelona 08035, Spain
- Grup de Recerca Cardiovascular, Vall d’Hebron Institut de Recerca, Barcelona 08035, Spain
- CIBER de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid 28029, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra 08193, Spain
| | - Pablo Jordan Marchite
- Unitat d’Arritmies Servei de Cardiologia VHIR, Hospital Universitari Vall d’Hebron, Barcelona 08035, Spain
| | - Jesús Rodríguez Silva
- Unitat d’Arritmies Servei de Cardiologia VHIR, Hospital Universitari Vall d’Hebron, Barcelona 08035, Spain
| | - Nuria Rivas Gándara
- Unitat d’Arritmies Servei de Cardiologia VHIR, Hospital Universitari Vall d’Hebron, Barcelona 08035, Spain
- CIBER de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid 28029, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra 08193, Spain
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Francisco-Pascual J, Rivas-Gándara N, Maymi-Ballesteros M, Badia-Molins C, Bach-Oller M, Benito B, Pérez-Rodón J, Santos-Ortega A, Roca-Luque I, Rodríguez-Silva J, Jordán-Marchite P, Moya-Mitjans À, Ferreira-González I. Arrhythmic risk in single or recurrent episodes of unexplained syncope with complete bundle branch block. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022:S1885-5857(22)00323-1. [PMID: 36539183 DOI: 10.1016/j.rec.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES Patients with a single syncopal episode (SSE) and complete bundle branch block (cBBB) are frequently managed more conservatively than patients with recurrent episodes (RSE). The objective of this study was to analyze if there are differences between patients with single or recurrent unexplained syncope and cBBB in arrhythmic risk, the diagnostic yield of tests, and clinical outcomes. METHODS Cohort study of consecutive patients with unexplained syncope and cBBB with a median follow-up time of 3 years. The patients were evaluated via a stepwise workup protocol based on electrophysiological study (EPS) and long-term follow-up with an implantable cardiac monitor. RESULTS Of the 503 patients included in the study, 238 (47.3%) had had only 1 syncopal episode. The risk of an arrhythmic syncope was similar in both groups (58.8% in SSE vs 57.0% in RSE; P=.68), also after adjustment for possible confounding variables (HR, 1.06; 95%CI, 0.81-1.38; P=.674). No significant differences between the groups were found in the EPS results and implantable cardiac monitor diagnostic yield. A total of 141 (59.2%) patients with SSE and 154 (58.1%) patients with RSE required cardiac device implantation (P=.797). After appropriate treatment, 35 (7%) patients had recurrence of syncope. The recurrence rate and mortality were also similar in both groups. CONCLUSIONS Patients with cBBB and unexplained syncope are at high risk of an arrhythmic etiology, even after the first syncopal episode. Patients with SSE and RSE have a similar arrhythmic risk and similar outcomes, and therefore there is no clinical justification for not managing them in the same manner.
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Affiliation(s)
- Jaume Francisco-Pascual
- Unitat d'Arrítmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Nuria Rivas-Gándara
- Unitat d'Arrítmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Manel Maymi-Ballesteros
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Clara Badia-Molins
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Montserrat Bach-Oller
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Begoña Benito
- Unitat d'Arrítmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Jordi Pérez-Rodón
- Unitat d'Arrítmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Alba Santos-Ortega
- Unitat d'Arrítmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Ivo Roca-Luque
- Unitat d'Arrítmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Unitat d'Arrítmies, Institut Clinic Cardiovascular, Hospital Clínic, Barcelona, Spain
| | - Jesús Rodríguez-Silva
- Unitat d'Arrítmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Pablo Jordán-Marchite
- Unitat d'Arrítmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Àngel Moya-Mitjans
- Unitat d'Arrítmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Servei de Cardiologia, Hospital Universitari Dexeus, Barcelona, Spain
| | - Ignacio Ferreira-González
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain; Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain
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Francisco-Pascual J, Rivas-Gándara N, Bach-Oller M, Badia-Molins C, Maymi-Ballesteros M, Benito B, Pérez-Rodon J, Santos-Ortega A, Sambola-Ayala A, Roca-Luque I, Cantalapiedra-Romero J, Rodríguez-Silva J, Pascual-González G, Moya-Mitjans À, Ferreira-González I. Sex-Related Differences in Patients With Unexplained Syncope and Bundle Branch Block: Lower Risk of AV Block and Lesser Need for Cardiac Pacing in Women. Front Cardiovasc Med 2022; 9:838473. [PMID: 35282384 PMCID: PMC8914040 DOI: 10.3389/fcvm.2022.838473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/21/2022] [Indexed: 11/16/2022] Open
Abstract
Objective To analyze if there are sex-related differences in patients with unexplained syncope and bundle branch block (BBB). Background Despite increasing awareness that sex is a major determinant of the incidence, etiology, and the outcomes of different arrhythmias, no studies have examined differences in presentation and outcomes between men and women with syncope and BBB. Methods Cohort study of consecutive patients with unexplained syncope and BBB was included from January 2010 to January 2021 with a median follow-up time of 3.4 years [interquartile range (IQR) 1.7–6.0 years]. They were evaluated by a stepwise workup protocol based on electrophysiological study (EPS) and long-term follow-up with an implantable cardiac monitor (ICM). Results Of the 443 patients included in the study, 165 (37.2%) were women. Compared with men, women had less diabetes (25.5 vs. 39.9%, p = 0.002) and less history of ischemic heart disease (IHD; 13.3 vs. 25.9%, p = 0.002). Left bundle branch block (LBBB) was more frequent in women (55.2 vs. 27.7%, p < 0.001) while right bundle branch block (RBBB) was more frequent in men (41.5 vs. 67.7%, p < 0.001). His to ventricle (HV) interval in the EPS was shorter in women (58 ms [IQR 52–71] vs. 60 ms [IQR 52–73], p = 0.035) and less women had an HV interval longer than 70 ms (28.5 vs. 38.1%, p = 0.039), however, EPS and ICM offered a similar diagnostic yield in both sexes (40.6 vs. 48.9% and 48.4% vs. 51.1%, respectively). Women had a lower risk of developing atrioventricular block (AVB) (adjusted odds ratio [OR] 0.44–95% CI 0.26–0.74, p = 0.002) and of requiring permanent pacemaker implantation (adjusted hazard ratio [HR] 0.72–95% CI: 0.52–0.99, p = 0.046). The mortality rate was lower in women (4.5 per 100 person-years [95% CI 3.1–6.4 per 100 person-years] vs. 7.3 per 100 person-years [95% CI 5.9–9.1 per 100 person-years]). Conclusions Compared to men, women with unexplained syncope and BBB have a lower risk of AVB and of requiring cardiac pacing. A stepwise diagnostic approach has a similar diagnostic yield in both sexes, and it seems appropriate to guide the treatment and avoid unnecessary pacemaker implantation, especially in women.
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Affiliation(s)
- Jaume Francisco-Pascual
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Nuria Rivas-Gándara
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Montserrat Bach-Oller
- Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Clara Badia-Molins
- Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Manel Maymi-Ballesteros
- Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Begoña Benito
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Jordi Pérez-Rodon
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Alba Santos-Ortega
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Antonia Sambola-Ayala
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Ivo Roca-Luque
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,Arrhythmia Section, Institut Clinic Cardiovascular, Hospital Clínic, Barcelona, Spain
| | - Javier Cantalapiedra-Romero
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Jesús Rodríguez-Silva
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Gabriel Pascual-González
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Àngel Moya-Mitjans
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Cardiology Department, Hospital Universitari Dexeus, Barcelona, Spain
| | - Ignacio Ferreira-González
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
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Sheldon RS, Lei LY, Solbiati M, Chew DS, Raj SR, Costantino G, Morillo C, Sandhu RK. Electrophysiology studies for predicting atrioventricular block in patients with syncope: A systematic review and meta-analysis. Heart Rhythm 2021; 18:1310-1317. [PMID: 33887450 DOI: 10.1016/j.hrthm.2021.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/07/2021] [Accepted: 04/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Syncope may be caused by intermittent complete heart block in patients with bundle branch block. Electrophysiology studies (EPS) testing for infra-Hisian heart block are recommended by the European Society of Cardiology syncope guidelines on the basis of decades-old estimates of their negative predictive values (NPVs) for complete heart block. OBJECTIVE The aim of this study was to determine the NPV of EPS for complete heart block in patients with syncope and bundle branch block. METHODS We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL without language restriction from database inception to October 2019 for Medical Subject Headings terms and keywords related to "syncope," "heart block," and "programmed electrical stimulation." A random effects meta-analysis was conducted with a primary outcome of the proportion of patients with a negative EPS who later presented with complete heart block, diagnosed with surface electrocardiographic (ECG) recordings vs continuous implantable cardiac monitor (ICM). RESULTS Ten reports contained 12 cohorts with 639 patients who met the inclusion criteria. The mean age was 69 ± 7 years; 35% ± 10% were women; and 85% of patients had bifascicular block. Seven cohorts recorded clinical outcomes with external ECG recordings, and 5 cohorts featured ICMs. The mean prespecified His-to-ventricle interval criterion was ≥70 ms. In studies featuring surface ECG recordings, there were 7% (95% confidence interval 7%-17%) patients who developed complete heart block compared with 29% (95% confidence interval 24%-35%) in the studies featuring ICM (P = .0001). CONCLUSION The NPV of EPS in patients with syncope and bundle branch block is 0.71, sufficiently low to question its use.
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Affiliation(s)
- Robert S Sheldon
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.
| | - Lucy Y Lei
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Monica Solbiati
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Università degli Studi di Milano, Milan, Italy
| | - Derek S Chew
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Satish R Raj
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Giorgio Costantino
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Università degli Studi di Milano, Milan, Italy
| | - Carlos Morillo
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Roopinder K Sandhu
- University of Alberta, Edmonton, Alberta, Canada; Smidt Heart Institute, Cedars-Sinai Hospital, Los Angeles, California
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Cardioinhibitory syncope: from pathophysiology to treatment—should we think on cardioneuroablation? J Interv Card Electrophysiol 2020; 59:441-461. [DOI: 10.1007/s10840-020-00758-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 04/23/2020] [Indexed: 02/07/2023]
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Goldberger ZD, Petek BJ, Brignole M, Shen WK, Sheldon RS, Solbiati M, Deharo JC, Moya A, Hamdan MH. ACC/AHA/HRS Versus ESC Guidelines for the Diagnosis and Management of Syncope. J Am Coll Cardiol 2019; 74:2410-2423. [DOI: 10.1016/j.jacc.2019.09.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 08/26/2019] [Accepted: 09/05/2019] [Indexed: 01/07/2023]
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Brignole M, Moya A, de Lange FJ, Deharo JC, Elliott PM, Fanciulli A, Fedorowski A, Furlan R, Kenny RA, Martín A, Probst V, Reed MJ, Rice CP, Sutton R, Ungar A, van Dijk JG. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J 2018; 39:1883-1948. [PMID: 29562304 DOI: 10.1093/eurheartj/ehy037] [Citation(s) in RCA: 954] [Impact Index Per Article: 159.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Assadian Rad M, Farahani M, Emkanjoo Z, Moladoust H, Alizadeh A. Predicting the outcome in patients with unexplained syncope and suspected cardiac cause: role of electrophysiologic studies. Anatol J Cardiol 2014; 15:213-7. [PMID: 25333981 PMCID: PMC5337057 DOI: 10.5152/akd.2014.5306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: Unexplained syncope is a challenge facing electrophysiologists. The prognosis varies widely depending on underlying causes, specially, cardiac ones. We sought to determine the abnormal electrophysiolgic (EP) study results as predictors of prognosis in syncope patients with suspected cardiac cause and risk factors associated with mortality. Methods: A total of 227 consecutive patients with unexplained syncope were prospectively enrolled in this study. EP study was performed in 177 patients in base of inclusion criteria. These patients, in whom a cardiac cause of syncope was suspected, underwent EP study and if negative, head-up tilts test (HUTT). Complete follow-up was obtained for 132 patients for 20.0±10.8 months. Results: A cardiac cause of syncope was established in 35%, a neurally mediated syncope in 35.6%, and in the rest 29.4% the cause of syncope remained unexplained despite a throughout neurologic and cardiologic evaluation. Logistic analysis revealed that the significant predictors of a cardiac cause of syncope were the absence of prodromal symptoms, left bundle branch block (LBBB), sever left ventricle (LV) dysfunction and male gender. At logistic analysis, the presence of LBBB (OR=6.63; 95% CI: 1.09-40) was significantly associated with outcome of death. Conclusion: The present study provides evidence that presence of LBBB, abnormal EP study result and structural heart disease (SHD) have prognostic value in patients with suspected cardiac cause of syncope. The patients with SHD and unexplained syncope who had a negative EP study have a good long-term prognosis even in the presence of LV dysfunction.
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Moya À, Sancho-Tello MJ, Arenal Á, Fidalgo ML, Brugada R, Martínez Ferrer J, Merino JL, Ruíz Mateas F, Mont JL. Innovations in heart rhythm disturbances: cardiac electrophysiology, arrhythmias, and cardiac pacing. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2013; 66:116-23. [PMID: 24775385 DOI: 10.1016/j.rec.2012.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 10/03/2012] [Indexed: 11/24/2022]
Abstract
This article reviews the most relevant articles published in 2012 in the field of arrhythmias, on subjects that include clinical arrhythmology, ablation, cardiac pacing, and the genetics of sudden cardiac death.
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Affiliation(s)
- Àngel Moya
- Unidad de Arritmias, Servicio de Cardiología, Universidad Autónoma de Barcelona, Hospital General Universitario Vall d'Hebron, Barcelona, Spain.
| | - María José Sancho-Tello
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Ángel Arenal
- Unidad de Arritmias, Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Ramon Brugada
- Centre de Genètica Cardiovascular IDIBGI y Facultad de Medicina, Universidad de Girona, Girona, Spain
| | - José Martínez Ferrer
- Unidad de Arritmias, Servicio de Cardiología, Hospital General de Araba, Vitoria, Álava, Spain
| | - José Luis Merino
- Unidad de Electrofisiología Cardiaca Robotizada, Servicio de Cardiología, Hospital La Paz, Madrid, Spain
| | - Francisco Ruíz Mateas
- Unidad de Estimulación Cardiaca, Servicio de Cardiología, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - Josep Lluis Mont
- Unidad de Arritmias, Servicio de Cardiología, Hospital Clínic, Barcelona, Spain
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Novedades en alteraciones del ritmo cardiaco: electrofisiología cardiaca, arritmias y estimulación cardiaca. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2012.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Merlos P, Rumiz E, Ruiz-Granell R, Martinez A, Izquierdo MT, Ferrero A, Dominguez E, Sanchez JM, Morell S, Garcia-Civera R. Outcome of patients with syncope beyond the implantable loop recorder. Europace 2012; 15:122-6. [DOI: 10.1093/europace/eus264] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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