[Natural history of syncope of undetermined origin with inconclusive electrophysiologic examination].
Between 1985 and 1986, 109 consecutive patients with unexplained syncope after clinical and standard electrocardiographic examination underwent electrophysiological investigation. In 61 cases (56%), 35 men and 26 women (mean age 69 +/- 13 years) no firm diagnosis could be made. These patients were the study group. Underlying cardiac disease was present in 23%, coronary artery disease in 10% of cases. In 33 cases, the basal ECG was normal (54%). Sixty patients (one lost to follow-up) were studied over an average of 38 +/- 12 months. Global mortality and recurrence rate were 13 and 18% respectively. There were no sudden deaths in the 8 fatalities. The mechanism of the 17 recurrent syncopes was cardiac in 5 cases, vasovagal in 1 case, uncertain in 11 cases. Of the 5 cardiac syncopes, 3 were related to 3rd degree atrioventricular block occurring 7 to 49 months after the initial electrophysiological investigation. No predictive criteria of recurrence could be identified. Empiric treatment proposed to 28% of patients did not prevent recurrent syncope and did not improve global survival. Inconclusive electrophysiological investigation of patients with unexplained syncope defines a population with a low risk of sudden death. Recurrent syncope is common. The recurrence of symptoms is an indication to repeat the aetiological investigations which should include a tilt-test ot another electrophysiological investigation. Empiric treatment has not been shown to be effective.
Gouello
J P
JP
Service de cardiologie, CHU d'Angers.
Victor
J
J
Tadei
A
A
D000206:Actuarial Analysis; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000175:diagnosis*; D004562:Electrocardiography; D004594:Electrophysiology; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D015996:Survival Rate; D013575:Syncope / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality
Histoire naturelle des syncopes d'étiologie indéterminée avec exploration électrophysiologique non concluante.