[Dilated cardiomyopathy and syncope: management]

Syncope occurring in patients with primary dilated cardiac disease has several causes: ventricular tachycardia (VT), a major severe cause of this diagnosis, occurring however only in one third of cases. The other causes are supraventricular tachycardia, bradycardia and vagal hyperactivity. The management depends on the etiology of syncope in one hand and the severity of the cardiac disease and other comorbidities in the other hand. In 2007, a patient with life expectancy exceeding one year, without irreducible heart failure but with a known and stable altered left ventricular ejection fraction (LVEF)<30%, will probably benefit of non-drug technology for the treatment of syncope (defibrillator with or without resynchronization), possibly in association with the treatment of another identified etiology, such as ablation or anti-arrhythmic treatment of a supraventricular tachycardia. In a patient with LVEF>30%, the electrophysiology exploration remains the most reliable recommended investigation for identifying the cause of syncope prior to discuss the implantation of a portable Holter device, indicated when the electrophysiology study is negative and syncope repeating.