[Transesophageal electrophysiologic study: utility in the diagnosis of syncope]

Neurocardiogenic and arrhythmic syncope are very common and may be found in many patients in Emergency Departments or admitted to hospitals. Technologic advances now allow etiologic diagnosis to be determined but the importance of a detailed clinical history and physical examination can not be overemphasized in the evaluation of syncope, thereby to avoid some costly or invasive procedures. The recent introduction of the head-up tilt test alone or in combination with electrophysiologic studies, has significantly improved our ability to diagnose the etiology of syncope in many cases. Suspicion of an arrhythmic cause of syncope does not always require an invasive electrophysiologic study since the transesophageal electrophysiologic study is useful and provides a high diagnostic yield in the evaluation of non ventricular arrhythmic syncope, such as in the sick sinus syndrome, atrio-ventricular block or in supraventricular tachycardia and for the study of atrial stability. The transesophageal electrophysiologic study is an inexpensive non invasive procedure which does not require complex hospitalary installations.