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Cited by 49Cardiovascular Syncope and Autonomic DisordersCardiac electrophysiology and arrhythmiasCardiac Arrhythmias and Treatments

Differences in mechanisms and outcomes of syncope in patients with coronary disease or idiopathic left ventricular dysfunction as assessed by electrophysiologic testing

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Brembilla-Perrot, Béatrice, Suty-Selton, Christine, Beurrier, Daniel, Houriez, Pierre, Nippert, Marc, Terrier de la Chaise, Arnaud, Louis, Pierre, Claudon, Olivier +4 more·2004·Journal of the American College of Cardiology
DOI 10.1016/j.jacc.2004.03.075
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Abstract

Objectives This study evaluated the causes of syncope and the significance and differences in left ventricular (LV) dysfunction, coronary disease, and idiopathic dilated cardiomyopathy (DCM).Background Risk stratification of and indications for an automated defibrillator could differ according to the cause of LV dysfunction.Methods Electrophysiologic study, including atrial and ventricular programmed stimulation, was performed in 119 patients with coronary disease (group I) and 61 patients with DCM (group II) with an left ventricular ejection fraction (LVEF) <40% and syncope. Patients were followed from one to six years (mean 4 +/- 2 years).Results Sustained monomorphic ventricular tachycardia (VT) was induced in 44 group I patients (37%) and 13 group II patients (21%); ventricular flutter (>270 beats/min) or ventricular fibrillation (VF) was induced in 24 group I patients (19%) and 9 group II patients (15%); and various other arrhythmias were identified. Syncope remained unexplained in 34 group I patients (30%) and 16 group II patients (27%). Prognosis depended on the heart disease: VT or VF induction was a predictive factor of mortality in coronary disease and identified a group with high cardiac mortality (46%), compared with patients with a negative study, who had a lower mortality (6%; p < 0.001) than in other studies. Cardiac mortality was only correlated with LVEF in DCM.Conclusions Various causes could explain syncope in 70% of patients with coronary disease and DCM, but differences were noted: VT was frequent in coronary disease with a bad prognosis, and ischemia could explain syncope; in DCM, different causes such as atrial tachycardia could be responsible for syncope, but the prognosis only depended on LVEF.

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  • Cardiac ischaemia-related syncope is confirmed when syncope presents with evidence of acute myocardial ischaemia with or without myocardial infarction.

    “Cardiac ischaemia-related syncope is confirmed when syncope presents with evidence of acute myocardial ischaemia with or without myocardial infarction. 25-39”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [28]

  • Arrhythmic syncope is highly probable when the ECG shows persistent sinus bradycardia <40 b.p.m. or sinus pauses >3 s in awake state and in absence of physical training; Mobitz II second- and third-degree AV block; alternating left and right BBB; VT or rapid paroxysmal SVT.

    “Arrhythmic syncope is highly probable when the ECG shows 25-39 : • Persistent sinus bradycardia <40 b.p.m. or sinus pauses >3 s in awake state and in absence of physical training; • Mobitz II second- and third-degree AV block; • Alternating left and right BBB; • VT or rapid paroxysmal SVT;”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [28]

  • Data from observational studies in selected cohorts show a high rate of occurrence of ventricular arrhythmias, ICD discharge, and death in patients with a history of unexplained syncope, but owing to a lack of control groups are unable to show the benefit of an ICD.

    “Data from observational studies in selected cohorts show a high rate of occurrence of ventricular arrhythmias, ICD discharge, and death in patients with a history of unexplained syncope but, owing to a lack of control groups, are unable to show the benefit of an ICD. 27,28,359,360”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [28]

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Authors
Brembilla-Perrot, B., Suty-Selton, C., Beurrier, D., Houriez, P., Nippert, M., Terrier de la Chaise, A., Louis, P., Claudon, O., Andronache, M., Abdelaah, A., Sadoul, N., & Juillière, Y.
Affiliations
Centre Hospitalier Régional et Universitaire de Nancy (FR)
Corresponding author
Brembilla-Perrot, Béatrice
ORCID
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
2004-08
Volume
44
Issue
3
Pages
594-601
ISSN
0735-1097 (ISSN-L)
DOI
10.1016/j.jacc.2004.03.075
OpenAlex
W2021441438
Cited by
49
References
33
Citations by year
2024: 1 · 2023: 5 · 2022: 1 · 2021: 1 · 2020: 3 · 2019: 1 · 2018: 5 · 2017: 3 · 2016: 1 · 2015: 2 · 2013: 2 · 2012: 2
FWCI
3.12
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the American College of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
Keywords
syncope, coronary disease, idiopathic dilated cardiomyopathy, left ventricular dysfunction, ventricular tachycardia, ventricular fibrillation, ventricular flutter, programmed electrical stimulation, left ventricular ejection fraction, cardiac mortality, prognosis, atrial tachycardia, ischemia
MeSH terms
Aged, Aged, 80 and over, Cardiomyopathy, Dilated, Coronary Artery Disease, Female, Follow-Up Studies, Humans, Male, Middle Aged, Predictive Value of Tests, Prognosis, Stroke Volume, Syncope, Ventricular Fibrillation, Survival Analysis, Treatment Outcome, Defibrillators, Implantable, Ventricular Dysfunction, Left, Risk Assessment

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