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Evaluation of the patients with syncope during the first month after coronary artery bypass graft
Abolfath Alizadeh1, Majid Kiavar, Mohammad Assadian-Rad
1Department of Pacemaker and Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Insights
Syncope after coronary artery bypass graft (CABG) may indicate orthostatic intolerance, not just arrhythmias. Prolonged bed rest post-CABG is a significant risk factor for syncope.
Area of Science:
- Cardiology
- Clinical Electrophysiology
Background:
- Syncope is a known risk factor for adverse cardiovascular events in patients with coronary artery disease, particularly after myocardial infarction (MI) or with left ventricular dysfunction.
- Post-coronary artery bypass graft (CABG) syncope requires careful evaluation to differentiate causes.
Purpose of the Study:
- To evaluate electrophysiologic findings and head-up tilt test (HUTT) results in patients experiencing syncope within the first month after CABG.
- To identify potential contributing factors to syncope in the early post-CABG period.
Main Methods:
- Prospective enrollment of 20 patients with syncope within one month post-CABG.
- Performance of electrophysiologic study (EPS) and head-up tilt test (HUTT) in all participants.
Main Results:
- Electrophysiologic study (EPS) was negative in 18 patients, suggesting non-arrhythmic causes.
- Head-up tilt test (HUTT) was positive in 10 patients, indicating orthostatic intolerance.
- A significant correlation was found between prolonged bed rest duration and positive HUTT (P=0.021).
Conclusions:
- Orthostatic intolerance should be considered as a cause of syncope in the early post-CABG period, even when arrhythmias are suspected.
- Extended periods of bed rest following CABG may predispose patients to syncope.
Background:
Syncope is a well-known risk factor for adverse cardiovascular event in patients with coronary artery disease, especially those with previous myocardial infarction (MI) or left ventricular dysfunction. The aim of this study was to assess electrophysiologic findings and results of head-up tilt test (HUTT) in patients with syncope and without orthostatic changes in blood pressure during the first month after coronary artery bypass graft (CABG).
Materials And Methods:
A total of 20 patients with syncope during the first month after CABG were prospectively enrolled in this study from June 2002 to April 2006. Electrophysiologic study (EPS) was performed in all of them. HUTT was performed in all of the patients regardless of the result of EPS.
Results:
The mean age of patients was 60.3±11 years. Twelve patients were males. EPS was negative in 18 patients. HUTT was positive in 10 patients. Six patients had old MI. Ischemic insult occurred in one patient after CABG. Left bundle branch was present in two patients. There was a significant relationship between the duration of bed rest after CABG and positive HUTT (P value = 0.021). All of the patients except one did not experience syncope during the follow-up period.
Conclusion:
In patients with syncope during the first month post CABG, in whom an arrhythmic cause is suspected, the other cause of syncope like orthostatic intolerance should be considered. Being bedridden for an extended period of time post CABG can be a predisposing factor.
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