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[Tachycardia-induced syncopes]

J Koerfer1, M Fromer

  • 1Division de Cardiologie, CHUV, Lausanne.

Therapeutische Umschau. Revue Therapeutique
|March 1, 1997
PubMed
Summary
This summary is machine-generated.

Cardiac causes account for half of syncope cases, with ventricular tachycardia (VT) being a frequent culprit. Early diagnosis and treatment of VT and other cardiac arrhythmias are crucial for preventing sudden cardiac death.

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Internal Medicine

Context:

  • Syncope, or fainting, is often cardiac in origin, with a significant incidence of sudden death.
  • Ventricular tachycardia (VT) is a primary cause of syncope and carries a high risk of progressing to fibrillation, especially with underlying heart disease.

Purpose:

  • To outline a diagnostic strategy for syncope, focusing on identifying cardiac causes, particularly VT.
  • To review diagnostic tools and treatment options for tachycardia-induced syncope.

Summary:

  • Cardiac syncope necessitates a thorough evaluation including history, ECG, echocardiography, stress testing, and electrophysiological studies (EPS) to identify conditions like Wolff-Parkinson-White syndrome, long QT, myocardial infarction, CAD, and cardiomyopathies.
  • While ambulatory ECG has limited diagnostic yield, >10 PVC/h or asymptomatic non-sustained VT predict sudden death. Late potentials aid in predicting inducible VT during EPS, though their clinical utility is debated.

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  • EPS is reserved for complex cases, with a negative EPS correlating to low cardiovascular mortality. Treatment for SVT includes antiarrhythmic drugs or radiofrequency ablation, while VT often requires ICD implantation.

    • Impact:

    • Establishes a diagnostic pathway for syncope, improving risk stratification and patient outcomes.
    • Highlights the importance of identifying and treating cardiac arrhythmias to reduce sudden cardiac death.
    • Provides evidence-based recommendations for managing tachycardia-induced syncope, emphasizing ablation for SVT and ICDs for VT.