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CLINICAL RESEARCH

Differences in mechanisms and outcomes of syncope in patients with coronary disease or idiopathic left ventricular dysfunction as assessed by electrophysiologic testing

^* Department of Cardiology, CHU of Brabois, Vandoeuvre Les Nancy, France

Manuscript received September 23, 2003; revised manuscript received February 20, 2004, accepted March 2, 2004.

^* Reprint requests and correspondence: Dr. Béatrice Brembilla-Perrot, Cardiologie, CHU de Brabois, 54500 Vandoeuvre Les Nancy, France.
b.brembilla-perrot{at}chu-nancy.fr

This study was presented at the 75th Scientific Sessions of the American Heart Association, November 2002, Chicago, IL.

OBJECTIVES: This study evaluated the causes of syncope and the significance and differences in left ventricular (LV) dysfunction, coronary disease, and idiopathic dilated cardiomyopathy (DCM).

BACKGROUND: Risk stratification of and indications for an automated defibrillator could differ according to the cause of LV dysfunction.

METHODS: Electrophysiologic study, including atrial and ventricular programmed stimulation, was performed in 119 patients with coronary disease (group I) and 61 patients with DCM (group II) with an left ventricular ejection fraction (LVEF) <40% and syncope. Patients were followed from one to six years (mean 4 ± 2 years).

RESULTS: Sustained monomorphic ventricular tachycardia (VT) was induced in 44 group I patients (37%) and 13 group II patients (21%); ventricular flutter (>270 beats/min) or ventricular fibrillation (VF) was induced in 24 group I patients (19%) and 9 group II patients (15%); and various other arrhythmias were identified. Syncope remained unexplained in 34 group I patients (30%) and 16 group II patients (27%). Prognosis depended on the heart disease: VT or VF induction was a predictive factor of mortality in coronary disease and identified a group with high cardiac mortality (46%), compared with patients with a negative study, who had a lower mortality (6%; p < 0.001) than in other studies. Cardiac mortality was only correlated with LVEF in DCM.

CONCLUSIONS: Various causes could explain syncope in 70% of patients with coronary disease and DCM, but differences were noted: VT was frequent in coronary disease with a bad prognosis, and ischemia could explain syncope; in DCM, different causes such as atrial tachycardia could be responsible for syncope, but the prognosis only depended on LVEF.

Abbreviations and Acronyms   AV = atrioventricular   BP = blood pressure   DCM = dilated cardiomyopathy   EPS = electrophysiologic study   HF = heart failure   ICD = implantable cardioverter-defibrillator   LV = left ventricular   LVEF = left ventricular ejection fraction   MI = myocardial infarction   SVTA = supraventricular tachyarrhythmia   VF = ventricular fibrillation   VT = ventricular tachycardia

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				Developed in collaboration with, European Heart Rhythm Association (EHRA), Heart Failure Association (HFA), and Heart Rhythm Society (HRS), Endorsed by the following societies, European Society of Emergency Medicine (EuSEM), European Federation of Internal Medicine (EFIM), European Union Geriatric Medicine Society (EUGMS), American Geriatrics Society (AGS), European Neurological Society (ENS), et al. Guidelines for the diagnosis and management of syncope (version 2009): The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC) Eur. Heart J., November 1, 2009; 30(21): 2631 - 2671. [Full Text] [PDF]

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