Jasbir S. Sra, MD; Alfred J. Anderson, MS; Shabbir H. Sheikh, MD; Boaz Avitall, MD, PhD; Patrick J. Tchou, MD; Paul J. Troup, MD; Carol J. Gilbert, RN; Masood Akhtar, MD; Mohammad R. Jazayeri, MD
Objective: To determine the clinical characteristics of subgroups of patients with unexplained syncope having electrophysiologic studies and head-up tilt testing and to assess the efficacy of various therapies.
Design: Retrospective study.
Setting: Inpatient services of a tertiary referral center.
Patients: Eighty-six consecutively referred patients with unexplained syncope.
Measurements: All patients had electrophysiologic examinations. Patients with negative results subsequently had head-up tilt testing.
Main Results: Twenty-nine (34%) patients (group 1) had abnormal electrophysiologic results, with sustained monomorphic ventricular tachycardia induced in 72%. Thirty-four (40%) patients (group 2) had syncope provoked by head-up tilt testing. The cause of syncope remained unexplained in 23 (26%) patients (group 3). Structural heart disease was present in 76%, 6%, and 30% of groups 1, 2, and 3, respectively. In group 1, pharmacologic or nonpharmacologic therapy was recommended based on electrophysiologic evaluation. All group 2 patients had negative results on head-up tilt testing while receiving oral beta blockers (27 patients) or disopyramide (7 patients). Group 3 patients did not receive any specific therapy. During a median follow-up period of 18.5 months, syncope recurred in 9 (10%) patients.
Conclusions: The combination of electrophysiologic evaluation and head-up tilt testing can identify the underlying cause of syncope in as many as 74% of patients presenting with unexplained syncope. Therapeutic strategies formulated according to the results of these diagnostic tests appear to prevent syncope effectively in most patients.
Sra JS, Anderson AJ, Sheikh SH, Avitall B, Tchou PJ, Troup PJ, et al. Unexplained Syncope Evaluated by Electrophysiologic Studies and Head-up Tilt Testing. Ann Intern Med. ;114:1013–1019. doi: 10.7326/0003-4819-114-12-1013
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Published: Ann Intern Med. 1991;114(12):1013-1019.
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