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[Arrhythmic syncope and invasive electrophysiologic heart function tests]
Insights
Electrophysiological examination identified arrhythmic syncopes in nearly half of patients with brief loss of consciousness. Severe arrhythmias detected via ECG monitoring significantly increased the likelihood of an arrhythmic syncope diagnosis.
Area of Science:
- Cardiology
- Electrophysiology
- Neurology
Context:
- Brief disorders of consciousness (syncope) often present diagnostic challenges.
- Extracardiac causes, impaired cardiac blood flow, and sinoatrial node dysfunction were excluded.
- 100 patients underwent electrophysiological examination.
Purpose:
- To determine the prevalence and diagnostic yield of arrhythmic syncopes in patients with brief disorders of consciousness.
- To assess the correlation between severe arrhythmias detected by ECG monitoring and the diagnosis of arrhythmic syncope.
Summary:
- Forty-three patients exhibited severe arrhythmias (ventricular tachycardia, ventricular extrasystoles, AV blocks, supraventricular tachycardia) during ECG monitoring.
- Fifty-seven patients had no severe arrhythmias on initial ECG monitoring.
- Invasive examination confirmed arrhythmic syncopes in 49% of all patients, with a 70% diagnosis rate in those with severe arrhythmias and 33% in those without.
Impact:
- Highlights the significant role of arrhythmias in causing syncope, even in the absence of overt ECG abnormalities.
- Suggests that electrophysiological evaluation is crucial for diagnosing arrhythmic syncopes.
- Informs clinical practice regarding the workup of unexplained brief loss of consciousness.
Abstract:
The authors submitted to electrophysiological examination a total of 100 patients (66 men and 34 women) with brief disorders of consciousness where they ruled out extracardiac causes of unconsciousness, impaired blood flow through the heart and the syndrome of s-a node dysfunction. Forty-three subjects had severe arrhythmias during ECG monitoring in bed or by Holter's system (20 subjects paroxysms of ventricular tachycardia, 14 subjects ventricular extrasystoles according to Lown class 3-5, six subjects had transient high-grade a-v blocks, three subjects had symptomatic paroxysms of supraventricular tachycardia). In 57 patients ECG monitoring did not reveal ectopic arrhythmias and high-grade a-v blocks. Invasive examination confirmed or diagnosed arrhythmic syncopes in 49% of the entire group of 100 patients. It assessed the arrhythmic cause of syncopes in 33% of 57 subjects without severe arrhythmias and in 70% of 43 subjects with severe arrhythmias detected during ECG monitoring.