Document Detail

Long-term outcome of patients with unexplained syncope treated with an electrophysiologic-guided approach in the implantable cardioverter-defibrillator era.
MedLine Citation:
PMID:  10520794     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: We evaluated the long-term outcome of patients with coronary artery disease and unexplained syncope who were treated with an electrophysiologic (EP)-guided approach. BACKGROUND: Electrophysiologic studies are frequently performed to evaluate unexplained syncope in patients with coronary artery disease. Patients with this profile who have inducible ventricular tachycardia are considered at high risk for sudden death and increased overall mortality, and therefore are often treated with an implantable cardioverter-defibrillator (ICD). The impact of this EP-guided strategy is unknown because there are no data comparing the long-term outcome of ICD recipients with that of noninducible patients. METHODS: We evaluated 67 consecutive patients with coronary artery disease and unexplained syncope. All patients were treated with an EP-guided approach that included ICD implantation in patients with inducible ventricular tachycardia. RESULTS: Electrophysiologic testing suggested a plausible diagnosis in 32 (48%) of these patients. Inducible monomorphic ventricular tachycardia was the most common abnormality. Despite frequent appropriate therapy with ICDs, the total mortality for patients with inducible monomorphic ventricular tachycardia was significantly higher than for noninducible patients. The respective one- and two-year survival rates were 94% and 84% in noninducible patients and 77% and 45% in inducible patients (p = 0.02). CONCLUSIONS: Electrophysiologic testing suggests an etiology for unexplained syncope in approximately 50% of patients and risk stratifies these patients with regard to long-term outcome. Patients who receive an ICD for the management of inducible ventricular tachycardia have a high incidence of spontaneous ventricular arrhythmias requiring ICD therapy. However, despite ICD implantation and frequent appropriate delivery of ICD therapies, patients with inducible ventricular tachycardia have a significantly worse prognosis than do those who are noninducible.
S Mittal; S Iwai; K M Stein; S M Markowitz; D J Slotwiner; B B Lerman
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  34     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  1999 Oct 
Date Detail:
Created Date:  1999-10-27     Completed Date:  1999-10-27     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1082-9     Citation Subset:  AIM; IM    
Department of Medicine, the New York Hospital-Cornell University Medical Center, New York 10021, USA.
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MeSH Terms
Aged, 80 and over
Cardiac Pacing, Artificial
Coronary Disease / diagnosis*,  physiopathology,  therapy
Death, Sudden, Cardiac / epidemiology,  etiology,  prevention & control
Defibrillators, Implantable*
Follow-Up Studies
Middle Aged
Risk Factors
Survival Rate
Syncope / etiology*,  physiopathology,  prevention & control
Tachycardia, Ventricular / diagnosis*,  physiopathology,  therapy
Treatment Outcome
Grant Support
Comment In:
J Am Coll Cardiol. 1999 Oct;34(4):1096-8   [PMID:  10520796 ]

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