Implantable Cardioverter Defibrillator Utilization Among Device Recipients Presenting Exclusively with Syncope or Near‐Syncope
Abstract
Introduction Implantable cardioverter defibrillators (ICDs) are occasionally used in presumed high-risk patients with electrocardiographically undocumented syncope, although the incidence of ventricular tachyarrhythmias in this population is not well defined. Methods and results We studied 33 consecutive patients receiving an ICD (67% nonthoracotomy and 70% tiered therapy) after electrophysiologic testing for unmonitored "syncope" (n = 29) or "near-syncope" (n = 4). Atherosclerotic heart disease was present in 24 (73%); mean left ventricular ejection fraction (LVEF) was 0.39 +/- 0.15; and sustained monomorphic ventricular tachycardia (SMVT) was inducible in 18 (55%). Over a median follow-up of 17 months (range 4 to 61), 12 patients (36%) received > or = 1 appropriate ICD discharge triggered by SMVT (cycle length 230 to 375 msec) in 10 and ventricular flutter or fibrillation in 2--without concomitant antiarrhythmic medication in 8 of 12 cases. Inducible SMVT and LVEF 0.35 (P Conclusion In this highly select, multicenter population of ICD recipients with electrocardiographically undocumented syncope, a substantial incidence of appropriate device discharges was observed, particularly in patients with inducible SMVT and LVEF < or = 0.35. These findings support the notion that, in patients with LV dysfunction and inducible SMVT, ventricular tachyarrhythmias are likely to account for episodes of syncope or near-syncope.
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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 [193]
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Syncope in advanced heart failure: high risk of sudden death regardless of origin of syncope
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2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope
Shen, W.-K., Sheldon, R. S., Benditt, D. G., Cohen, M. I., Forman, D. E., Goldberger, Z. D., Grubb, B. P., Hamdan, M. H., Krahn, A. D., Link, M. S., et al. (2017) · Heart Rhythm · doi:10.1016/j.hrthm.2017.03.004 · Cited by 484 · see citing works
2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope
Shen, W.-K., Sheldon, R. S., Benditt, D. G., Cohen, M. I., Forman, D. E., Goldberger, Z. D., Grubb, B. P., Hamdan, M. H., Krahn, A. D., Link, M. S., et al. (2017) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2017.03.003 · Cited by 327 · see citing works
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Cost implications of testing strategy in patients with syncope
Krahn, A. D., Klein, G. J., Yee, R., Hoch, J. S., & Skanes, A. C. (2003) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(03)00659-4 · Cited by 170 · see citing works
Syncope Predicts the Outcome of Cardiomyopathy Patients
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- Authors
- MILITIANU, A., SALACATA, A., SEIBERT, K., KEHOE, R., BAGA, J. J., MEISSNER, M. D., PIRES, L. A., SCHUGER, C. D., STEINMAN, R. T., MOSTELLER, R. D., PALTI, A. J., BEN DAVID, J., LESSMEIER, T. J., & LEHMANN, M. H.
- Affiliations
- St. John Hospital & Medical Center (US)
- Wayne State University (US)
- Advocate Illinois Masonic Medical Center (US)
- Summa Health System (US)
- Carmel Medical Center (IL)
- Corresponding author
- LEHMANN, MICHAEL H.
- Venue
- Journal of Cardiovascular Electrophysiology
- Publisher
- Wiley
- Published
- 1997-10
- Volume
- 8
- Issue
- 10
- Pages
- 1087-1097
- ISSN
- 1045-3873 (ISSN-L)
- 1540-8167
- OpenAlex
- W2112168801
- Cited by
- 50
- References
- 1
- Citations by year
- 2020: 1 · 2018: 1 · 2017: 4 · 2016: 1 · 2015: 1 · 2014: 2 · 2013: 2 · 2012: 2
- FWCI
- 2.16
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Cardiovascular Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- implantable cardioverter-defibrillator, syncope, presyncope, monomorphic ventricular tachycardia, left ventricular ejection fraction, ventricular tachyarrhythmia, atherosclerotic heart disease
- MeSH terms
- Adult, Aged, Aged, 80 and over, Data Collection, Electric Countershock, Electrocardiography, Electric Stimulation Therapy, Female, Follow-Up Studies, Heart Function Tests, Humans, Male, Middle Aged, Syncope, Survival Analysis, Defibrillators, Implantable
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