title: What is The Utility of Electrophysiological Study in Elderly Patients with Syncope and Heart Disease?
abstract: BACKGROUND
  Syncope in elderly patients with heart disease is a growing problem. Its aetiological diagnosis is often difficult. We intended to investigate the value of the electrophysiological study (EPS) in old patients with syncope and heart disease.
  
  
  METHODS
  EPS was performed in 182 consecutive patients with syncope and heart disease, among whom 62 patients were ≥75 years old and 120 patients <75.
  
  
  RESULTS
  Left ventricular ejection fraction was 43.9±11.7% in patients ≥75 and 41.1±12.6% in patients <75. During EPS, induced sustained ventricular arrhythmias were as frequent in both groups (27.4% in patients ≥75 versus 27.5% in patients <75, p=0.99) whereas AV conduction abnormalities were more frequent in older patients (37.1% in patients ≥75 versus 18.3% in patients <75, p<0.005). Syncope remained unexplained in 35.5% of patients ≥75 and in 51.7% of patients <75 (p>0.04). ICD was more likely to be implanted in younger patients than in patients ≥75 years (37.5% vs 21% respectively, p<0.009). During a mean follow-up period of 3.3±3 years, the 4-year-survival rate was 66.9±6.8 % in patients ≥75 and 75.9±6.2 % in patients <75 years. The main cause of death was heart failure in both groups. The factors related to a worse outcome in a multivariate analysis were low LVEF and higher age.
  
  
  CONCLUSIONS
  Complete EPS allows the identification of treatable causes in a high proportion of elderly patients with syncope and heart disease. Yet, the prognosis of these patients is mainly related to LVEF and age.
authors: Department of Cardiology, Nancy University Hospital, Vandoeuvre-les-Nancy, France.
authors: Rumas
authors: R
authors: Aslam
authors: INSERM, Centre d'Investigations Cliniques 9501, Universite de Lorraine, Institut Lorrain du cour et des vaisseaux, CHU de Nancy, Nancy, France.
authors: Nicolas
authors: N
authors: Girerd
authors: Department of Cardiology, Nancy University Hospital, Vandoeuvre-les-Nancy, France.
authors: Beatrice
authors: B
authors: Brembilla-Perrot
keywords: elderly; electrophysiological study; heart disease; syncope