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Mecanismo de síncope en pacientes con enfermedad cardíaca y prueba electrofisiológica negativa
Carlo Menozzi1, Michele Brignole, Roberto Garcia-Civera
1Department of Cardiology, Ospedale S. Maria Nuova, Reggio Emilia, Italy.
Circulation
|June 12, 2002
Resumen
Los pacientes con enfermedad cardíaca estructural y síncope inexplicable tienen un buen pronóstico. Los grabadores de bucle implantables revelaron diversas causas, siendo poco probable la taquiarritmia ventricular.
Área de la Ciencia:
- Cardiología Cardiología.
- Electrofisiología y electrofisiología.
- Medicina interna es la medicina interna de las enfermedades.
Sus antecedentes:
- A menudo se presume que el síncope en pacientes con enfermedad cardíaca estructural proviene de arritmias cardíacas.
- Los mecanismos precisos siguen sin estar claros, sobre todo cuando los estudios electrofisiológicos iniciales arrojan resultados poco notables.
Objetivo del estudio:
- Investigar los mecanismos y resultados de síncope en pacientes con enfermedad cardíaca estructural y estudios electrofisiológicos negativos.
- Evaluar la utilidad de los registradores de bucle implantables en el diagnóstico de síncope en esta población de alto riesgo.
Principales métodos:
- Se utilizó un grabador de bucle implantable en 35 pacientes con enfermedad cardíaca estructural y antecedentes de síncope.
- Los pacientes tenían factores de riesgo de arritmia ventricular, incluido un infarto de miocardio previo, fracción de eyección reducida o taquicardia ventricular no sostenida.
- El seguimiento varió de 3 a 15 meses.
Principales resultados:
- El síncope se repitió en 6 pacientes (17%), con mecanismos que incluyen bradicardia (bloqueo AV, paro sinusal), taquicardia sinusal y aumento de la frecuencia ventricular en la fibrilación auricular crónica.
- Los episodios de presíncope (23%) involucraron varias variaciones de ritmo, incluida la fibrilación auricular / taquicardia y un caso de taquicardia ventricular sostenida.
- No se produjeron muertes ni lesiones relacionadas con síncope durante el período de estudio.
Conclusiones:
- Los pacientes con síncope inexplicable, enfermedad cardíaca estructural y estudios electrofisiológicos negativos demuestran resultados favorables a mediano plazo.
- Los mecanismos subyacentes del síncope en esta cohorte son diversos, y la taquiarritmia ventricular primaria es una causa poco frecuente.
- Los grabadores de bucle implantables son valiosos para el diagnóstico de síncope en pacientes con enfermedad cardíaca estructural.
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