JOHN P. DiMARCO, M.D., Ph.D.; HASAN GARAN, M.D.; J. WARREN HARTHORNE, M.D.; JEREMY N. RUSKIN, M.D.
Twenty-five patients with recurrent episodes of syncope, unexplained despite thorough medical and neurologic evaluation, underwent intracardiac electrophysiologic study with programmed stimulation. Electrophysiologic study yielded a presumptive diagnosis in 17 patients: nine with rapid ventricular tachycardia induced by programmed stimulation, three with intra-His conduction delays, one with symptomatic atrial flutter, one with sick sinus syndrome, and three with persistent hypervagotonia manifested as atropine-reversible prolongation of atrioventricular nodal refractoriness. Therapy based on these findings provided complete symptomatic relief in 14 and improvement in one of these 17 patients during a mean follow-up of 18 ± 10 months. Therapy based on electrophysiologic testing was ineffective in two of the 17 patients. Syncope persisted in four of the eight patients in whom electrophysiologic study did not define a probable arrhythmic mechanism. These observations indicate that full electrophysiologic evaluation with programmed stimulation is useful in the diagnosis and therapy of recurrent unexplained syncope.
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DiMARCO JP, GARAN H, HARTHORNE JW, RUSKIN JN. Intracardiac Electrophysiologic Techniques in Recurrent Syncope of Unknown Cause. Ann Intern Med. 1981;95:542–548. doi: 10.7326/0003-4819-95-5-542
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Published: Ann Intern Med. 1981;95(5):542-548.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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