Cardiac syncope: a case exhibiting dichotomy between clinical impression and electrophysiologic evaluation

Area of Science:

• Cardiology
• Electrophysiology
• Clinical Medicine

Background:

• Syncope and sudden cardiac death (SCD) pose diagnostic challenges, especially when electrocardiogram (ECG) and Holter monitoring show ambiguous findings.
• Patients may present with clinical markers suggesting both bradycardia and ventricular tachycardia, complicating initial assessment.
• Accurate diagnosis is critical to guide appropriate therapeutic interventions and improve patient outcomes.

Observation:

• A case report details a patient with unmonitored syncope and clinical signs of both bradycardia and ventricular tachycardia.
• Electrocardiogram (ECG) and Holter monitoring revealed a wide QRS complex and high-grade ventricular ectopic activity.
• The patient's presentation necessitated a detailed electrophysiologic study for definitive diagnosis.

Findings:

• Electrophysiologic study (EPS) proved invaluable in differentiating the underlying cause of the patient's symptoms.
• The findings highlighted that a clinical impression solely based on ventricular tachycardia could lead to inappropriate and risky treatment.
• The study identified specific electrophysiologic characteristics that distinguished the patient's condition.

Implications:

• This case underscores the importance of EPS in managing complex syncope and sudden cardiac death cases.
• Accurate diagnosis through EPS can prevent potentially harmful therapeutic decisions based on misinterpretations of clinical data.
• Electrophysiologic evaluation is essential for risk stratification and guiding personalized treatment strategies in cardiology.