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Cited by 71Cardiovascular Syncope and Autonomic DisordersCardiac pacing and defibrillation studiesCardiac electrophysiology and arrhythmias

Implantable defibrillator event rates in patients with unexplained syncope and inducible sustained ventricular tachyarrhythmias

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Andrews, Neil P, Fogel, Richard I, Pelargonio, Gemma, Evans, Joseph J, Prystowsky, Eric N·1999·Journal of the American College of Cardiology
DOI 10.1016/s0735-1097(99)00465-9
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Abstract

Objectives To assess the clinical significance of inducible ventricular tachyarrhythmias among patients with unexplained syncope. Background Induction of sustained ventricular arrhythmias at electrophysiology study in patients with unexplained syncope and structural heart disease is usually assigned diagnostic significance. However, the true frequency of subsequent spontaneous ventricular tachyarrhythmias in the absence of antiarrhythmic medications is unknown. Methods In a retrospective case-control study, the incidence of implantable cardiac defibrillator (ICD) therapies for sustained ventricular arrhythmias among patients with unexplained syncope or near syncope (syncope group, n = 22) was compared with that of a control group of patients (n = 32) with clinically documented sustained ventricular tachycardia (VT). Sustained ventricular arrhythmias were inducible in both groups and neither group received antiarrhythmic medications. All ICDs had stored electrograms or RR intervals. Clinical variables were similar between groups except that congestive cardiac failure was more common in the syncope group. Results Kaplan-Meier analysis of the time to first appropriate ICD therapy for syncope and control groups produced overlapping curves (p = 0.9), with 57 +/- 11% and 50 +/- 9%, respectively, receiving ICD therapy by one year. In both groups, the induced arrhythmia was significantly faster than spontaneous arrhythmias, but the cycle lengths of induced and spontaneous arrhythmias were positively correlated (R = 0.6, p < 0.0001). During follow-up, three cardiac transplantations and seven deaths occurred in the syncope group, and two transplantations and five deaths occurred in the control group (36-month survival without transplant 52 +/- 11% and 83 +/- 7%, respectively, p = 0.03). Conclusions In patients with unexplained syncope, structural heart disease and inducible sustained ventricular arrhythmias, spontaneous sustained ventricular arrhythmias occur commonly and at a similar rate to patients with documented sustained VT. Thus, electrophysiologic testing in unexplained syncope can identify those at risk of potentially life-threatening tachyarrhythmias, and aggressive treatment of these patients is warranted.

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  • The role of EPS in patients with syncope suspected to be due to VA and acquired nonischemic heart disease is unproven.

    “The role of EPS in patients with syncope suspected to be due to VA and acquired nonischemic heart disease is unproven (193–198).”

    From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [196]

    The Conclusions section says that assessing the true value of EPS in unexplained syncope has been difficult, and the Results section shows that only three patients in the syncope group had nonischemic heart disease. But the paper does not specifically state that EPS’s role in the claimed nonischemic population is unproven; its positive clinical implication is framed for patients with coronary artery disease. No page number is available for these passages in our copy. (LLM, conf=0.76)

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Research works printed but not linked: 29

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Cited by

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Authors
Andrews, N. P., Fogel, R. I., Pelargonio, G., Evans, J. J., & Prystowsky, E. N.
Corresponding author
Prystowsky, Eric N
ORCID
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
1999-12
Volume
34
Issue
7
Pages
2023-2030
ISSN
0735-1097 (ISSN-L)
DOI
10.1016/s0735-1097(99)00465-9
OpenAlex
W192296954
Cited by
71
References
0
Citations by year
2023: 2 · 2018: 1 · 2017: 4 · 2015: 2 · 2013: 3
FWCI
5.55
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 pacing and defibrillation studies
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
Keywords
unexplained syncope, implantable cardioverter-defibrillator, appropriate ICD therapy, structural heart disease, ventricular tachycardia, electrophysiologic testing, congestive heart failure
MeSH terms
Aged, Female, Heart Rate, Humans, Male, Retrospective Studies, Syncope, Electrocardiography, Ambulatory, Survival Rate, Treatment Outcome, Defibrillators, Implantable, Tachycardia, Ventricular

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