Predictors of ventricular tachycardia induction in syncopal patients with mild to moderate left ventricular dysfunction.
BACKGROUND
In patients with mild to moderate left ventricular dysfunction (LVD) (35% pound LVEF pound 50%) who present with syncope, demonstration of tachy and/or brady-arrhythmia has prognostic value. In this group of patients electrophysiological study (EPS) is often necessary.


METHODS
A total of 53 consecutive patients with mild to moderate LVD and history of undetermined syncope underwent EPS. Sinus node function, His-Purkinje system conduction and ventricular electrical stability were evaluated.


RESULTS
Twenty eight patients (52.8%) had induction of sustained monomorphic ventricular tachycardia (VT) and five (9.4%) patients had a sustained ventricular arrhythmia other than monomorphic VT (ventricular flutter, ventricular fibrillation, and polymorphic VT) induced during EPS. Abnormal sinus node function and/or His-Purkinje system conduction was found in five (9.4%) patients. Age, gender, history of myocardial infarction, type of underlying heart disease and history of revascularization were not predictors of VT induction. Wide QRS morphology independently, and lower left ventricular ejection fraction and presence of pathologic q wave in precordial leads dependently, could increase risk of VT induction.


CONCLUSIONS
The EPS can determine which patient with syncope and mild to moderate LVD is likely to benefit from placing an ICD for prevention of sudden cardiac death. Pathologic precordial q wave, wide QRS morphology and lower left ventricular ejection fraction could be predictors of VT induction during EPS. Wide QRS morphology has an independent effect in this category.
Fazelifar
Amir Farjam
AF
Department of Pacemaker and Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran. fazelifar@gmail.com
Ashrafi
Peyman
P
Haghjoo
Majid
M
Haghighi
Zahra Ojaghi
ZO
Abkenar
Hooman Bakhshandeh
HB
Ashour
Ashrafossadat
A
Azari
Shahrbanou
S
Forghanian
Azam
A
Sadr-Ameli
Mohammad Ali
MA
D000328:Adult; D000368:Aged; D002037:Bundle-Branch Block / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D012720:Severity of Illness Index; D012849:Sinoatrial Node / Q000503:physiopathology; D013575:Syncope / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D017180:Tachycardia, Ventricular / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology