Does syncope require rhythmic and non-rhythmic evaluation in patients with previous MI?
BACKGROUND
Multiple factors, in addition to left ventricular ejection fraction (LVEF) influence the risk of mortality in coronary artery disease. The purpose of this study was to evaluate the main causes of syncope after myocardial infarction (MI) and to propose an algorithm of management.


METHODS
356 patients consecutively admitted for syncope and history of MI (>1 month), without ventricular tachycardia (VT), underwent echocardiography, Holter monitoring, head-up tilt test, exercise testing, signal-averaged ECG, electrophysiological study (EPS) and evaluation of coronary status. The mean follow-up was 4±2 years.


RESULTS
Monomorphic VT, ventricular flutter or fibrillation (VF) and supraventricular tachyarrhythmia were respectively induced at EPS in 87, 63 and 39 patients; conduction disturbances were noted in 23 patients, and 57 patients had several abnormalities. Among the 144 patients with negative EPS, coronary ischaemia was identified in 37 patients, and hypervagotonia in 27 patients. All studies remain negative in 84 patients (23.6%), more frequently women (p<0.001). Four patients died suddenly during follow-up. A longer QRS duration, a lower LVEF and grade IVa,b of Lown on Holter ECG were associated with the induction of VT. LVEF<40% and VT/VF induction were predictors of cardiac mortality, VT was a predictor of sudden death, and low LVEF and advanced age were predictors of death by heart failure.


CONCLUSIONS
Myocardial ischaemia, hypervagotonia, conduction abnormalities, ventricular or supraventricular tachyarrhythmias were identified in 76% of patients with syncope after MI. Several factors of syncope were found in 57 patients (16%). Non-invasive rhythmological and systematic coronary status assessment should be recommended in patients with syncope following MI.
Cardiology, CHU of Brabois, Vandœuvre-lès-Nancy, France.
B
B
Brembilla-Perrot
Cardiology, CHU of Brabois, Vandœuvre-lès-Nancy, France.
C
C
Suty-Selton
Epidemiology, CHU, Nancy, France.
F
F
Alla
Cardiology, CHU of Brabois, Vandœuvre-lès-Nancy, France.
P Y
PY
Zinzius
Cardiology, CHU of Brabois, Vandœuvre-lès-Nancy, France.
H
H
Blangy
Cardiology, CHU of Brabois, Vandœuvre-lès-Nancy, France.
B
B
Azman
Cardiology, CHU of Brabois, Vandœuvre-lès-Nancy, France.
A
A
Terrier de la Chaise
Cardiology, CHU of Brabois, Vandœuvre-lès-Nancy, France.
P
P
Louis
Cardiology, CHU of Brabois, Vandœuvre-lès-Nancy, France.
L
L
Groben
Cardiology, CHU of Brabois, Vandœuvre-lès-Nancy, France.
K
K
Djaballah
Cardiology, CHU of Brabois, Vandœuvre-lès-Nancy, France.
O
O
Selton
Cardiology, CHU of Brabois, Vandœuvre-lès-Nancy, France.
S
S
Magalhaes
Cardiology, CHU of Brabois, Vandœuvre-lès-Nancy, France.
L
L
Muresan
Cardiology, CHU of Brabois, Vandœuvre-lès-Nancy, France.
J
J
Cedano
Cardiology, CHU of Brabois, Vandœuvre-lès-Nancy, France.
A
A
Abdelaal
Cardiology, CHU of Brabois, Vandœuvre-lès-Nancy, France.
N
N
Sadoul
Syncope; electrophysiological study; management; myocardial infarction; prognosis