Various causes could explain syncope in 70% of patients with coronary disease and DCM, but differences were noted: VT was frequent in coronary disease with a bad prognosis, and ischemia could explain syncope; in DCM, different causes such as atrial tachycardia could be responsible for syncope, but the prognosis only depended on LVEF.

BackgroundAspecific scoring systems are used to predict the risk of death postsurgery in patients with infective endocarditis (IE). The purpose of the present study was both to analyze the risk factors for in‐hospital death, which complicates surgery for IE, and to create a mortality risk score based on the results of this analysis.Methods and ResultsOutcomes of 361 consecutive patients (mean age, 59.1±15.4 years) who had undergone surgery for IE in 8 European centers of cardiac surgery were recorded prospectively, and a risk factor analysis (multivariable logistic regression) for in‐hospital death was performed. The discriminatory power of a new predictive scoring system was assessed with the receiver operating characteristic curve analysis. Score validation procedures were carried out. Fifty‐six (15.5%) patients died postsurgery. BMI >27 kg/m2 (odds ratio [OR], 1.79; P=0.049), estimated glomerular filtration rate <50 mL/min (OR, 3.52; P<0.0001), New York Heart Association class IV (OR, 2.11; P=0.024), systolic pulmonary artery pressure >55 mm Hg (OR, 1.78; P=0.032), and critical state (OR, 2.37; P=0.017) were independent predictors of in‐hospital death. A scoring system was devised to predict in‐hospital death postsurgery for IE (area under the receiver operating characteristic curve, 0.780; 95% CI, 0.734–0.822). The score performed better than 5 of 6 scoring systems for in‐hospital death after cardiac surgery that were considered.ConclusionsA simple scoring system based on risk factors for in‐hospital death was specifically created to predict mortality risk postsurgery in patients with IE.

Sudden death might be the first event in patients with asymptomatic WPW. The purpose of the study was to know if the age of the patient modifies the electrophysiological characteristics of asymptomatic WPW. Transesophageal stimulation was performed on 92 asymptomatic WPW patients from the following age groups: 10-69 years (n = 14), 20-29 years (n = 33), 30-39 years (n = 15), 40-49 years (n = 17), and 50-69 years (n = 13). The procedure consisted of atrial pacing up to the second AV block, programmed atrial stimulation using one and two extrastimuli delivered on two driven rhythms in the control state, and after infusion of isoproterenol. In thefive age groups, paroxysmal junctional tachycardia occurred, respectively, in 1 (7%), 1 (3%), 2 (13%), 2 (12%) patients, and not at all in the oldest group. AF > 1 minute occurred, respectively, in 3 (21%), 9 (27%), 5 (33%), 3 (18%), and 4 (31%) patients. The dangerous form of WPW (rapid conduction in the Kent bundle > 240/min in the control state or > 300/min after isoproterenol + AF induction) occurred, respectively, in 3 (21%), 9 (27%), 4 (27%), 1 (6%), and 3 (23%) patients. In conclusion, electrophysiological data of asymptomatic WPW are not modified by age of the patient. Elderly patients remain at risk of a dangerous form of WPW; systematic evaluation of WPWis recommended in patients with an active life independent of age.

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