Mechanism of syncope in patients with heart disease and negative electrophysiologic test
Abstract
BACKGROUND: In patients with syncope and structural heart disease, syncope is suspected to be attributable to a primary cardiac arrhythmia, but little is known of its mechanism when electrophysiologic study is unremarkable. METHODS AND RESULTS: We applied an implantable loop recorder in 35 patients with overt heart disease at risk of ventricular arrhythmia, because these were patients with previous myocardial infarction or cardiomyopathy with depressed ejection fraction or nonsustained ventricular tachycardia in whom an electrophysiologic study was unremarkable. During a follow-up of 3 to 15 months, syncope recurred in 6 patients (17%) after a mean of 6+/-5 months; in 3 patients, the mechanism of syncope was bradycardia with long pauses (sudden-onset AV block in 2 cases and sinus arrest in 1 case); in 1 patient, there was stable sinus tachycardia; and in 2 patients, who had chronic atrial fibrillation, there was an increase in ventricular rate. A total of 23 episodes of presyncope were documented in 8 patients (23%): no rhythm variation or mild tachycardia in 12 cases, paroxysmal atrial fibrillation or atrial tachycardia in 10 cases, and sustained ventricular tachycardia in 1 case. No patient died during the study period nor suffered from injury attributable to syncopal relapse. CONCLUSIONS: The patients with unexplained syncope, structural heart disease, and negative electrophysiologic study had a favorable medium-term outcome with no case of death and a low recurrence rate of syncope without related injury. The mechanism of syncope was heterogeneous, and ventricular tachyarrhythmia was unlikely.
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In patients with recurrent syncope of uncertain origin, absence of high-risk criteria and structural heart disease, and in suspected reflex syncope, an asystolic pause was present during syncope in about 50% of patients.
“Similar findings were subsequently observed with ILR use expanded in an early phase of evaluation in patients with recurrent syncope of uncertain origin, in the absence of highrisk criteria and structural heart disease, 176,180-183 and in suspected reflex syncope. 184-186 In particular, an asystolic pause was present during syncope in about 50% of these patients.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [180]
The Discussion reports that half of syncopal recurrences involved long ventricular asystole, supporting the approximately 50% figure. But the Abstract specifies that this study enrolled patients with overt structural heart disease at risk of ventricular arrhythmia, not patients without structural heart disease; suspected reflex syncope was not its study population. Page numbers are not available in the supplied copy. (LLM, conf=0.88)
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- Authors
- Menozzi, C., Brignole, M., Garcia-Civera, R., Moya, A., Botto, G., Tercedor, L., Migliorini, R., & Navarro, X.
- Affiliations
- Hospital Clínico Universitario de Valencia (ES)
- From the Department of Cardiology, Ospedale S. Maria Nuova (C.M.), Reggio Emilia; Ospedali del Tigullio (M.B.), Lavagna; Ospedale S. Anna (G.B.), Como; and Medtronic Italy (R.M.), Milan, Italy; and Hospital General Vall d’Hebron (A.M.), Barcelona; Hospital Clinico Universitario (R.G.C.), Valencia; Hospital Virgen de las Nieves (L.T.), Granada; and Medtronic Iberica (X.N.), Madrid, Spain.
- Corresponding author
- Brignole, Michele
- Venue
- Circulation
- Published
- 2002-06-11
- Volume
- 105
- Issue
- 23
- Pages
- 2741-2745
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2153070746
- Cited by
- 204
- References
- 22
- Citations by year
- 2026: 2 · 2024: 4 · 2023: 3 · 2021: 4 · 2020: 5 · 2019: 3 · 2018: 6 · 2017: 6 · 2016: 4 · 2015: 5 · 2014: 13 · 2013: 17 · 2012: 9
- FWCI
- 12.09
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (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, structural heart disease, implantable loop recorder, ventricular tachyarrhythmia, atrial fibrillation, sinus arrest, atrioventricular block, presyncope, ventricular tachycardia, cardiomyopathy, myocardial infarction, syncope recurrence
- MeSH terms
- Aged, Arrhythmias, Cardiac, Electrocardiography, Female, Follow-Up Studies, Humans, Male, Cardiomyopathies, Syncope, Disease-Free Survival, Prostheses and Implants, Electrophysiologic Techniques, Cardiac, Endpoint Determination
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