Selective use of diagnostic tests inpatients with syncope of unknown cause

García‐Civera, Roberto; Ruiz‐Granell, Ricardo; Morell-Cabedo, Salvador; Sanjuan-Mañez, Rafael; Perez-Alcala, Francisco; Plancha, Eva; Navarro, Alejandro; Botella, S; Llàcer, Àngel

doi:10.1016/s0735-1097(02)02929-7

Cited by 54 publications

(12 citation statements)

References 18 publications

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“…15 Because of the low yield of electrophysiological testing in patients without underlying heart disease, this test is not routinely recommended. 16,17 However, given the low risk of electrophysiological testing 18 and the high risk of recurrent syncope with potential harm to the patient, the risk-to-benefit ratio may favor electrophysiological testing in patients with a malignant episode of syncope.…”

Section: Electrophysiological Studymentioning

confidence: 99%

AHA/ACCF Scientific Statement on the Evaluation of Syncope

Strickberger¹,

Benson²,

Biaggioni³

et al. 2006

Circulation

259

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Section: Electrophysiological Studymentioning

confidence: 99%

AHA/ACCF Scientific Statement on the Evaluation of Syncope

Strickberger¹,

Benson²,

Biaggioni³

et al. 2006

Circulation

259

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“…On the basis of the premise that most cardiogenic syncope is related to an arrhythmia, tachyarrhythmia, or bradyarrhythmia, electrophysiological testing makes sense. The performance of a diagnostic protocol of syncope is clearly influenced by patient selection (18, 19). …”

Section: Discussionmentioning

confidence: 99%

Predicting the outcome in patients with unexplained syncope and suspected cardiac cause: Role of electrophysiologic studies

Rad¹,

Farahani²,

Emkanjoo³

et al. 2015

Anatol J Cardiol

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Objective:Unexplained syncope is a challenge facing electrophysiologists. The prognosis varies widely depending on underlying causes, specially, cardiac ones. We sought to determine the abnormal electrophysiolgic (EP) study results as predictors of prognosis in syncope patients with suspected cardiac cause and risk factors associated with mortality.Methods:A total of 227 consecutive patients with unexplained syncope were prospectively enrolled in this study. EP study was performed in 177 patients in base of inclusion criteria. These patients, in whom a cardiac cause of syncope was suspected, underwent EP study and if negative, head-up tilts test (HUTT). Complete follow-up was obtained for 132 patients for 20.0±10.8 months.Results:A cardiac cause of syncope was established in 35%, a neurally mediated syncope in 35.6%, and in the rest 29.4% the cause of syncope remained unexplained despite a throughout neurologic and cardiologic evaluation. Logistic analysis revealed that the significant predictors of a cardiac cause of syncope were the absence of prodromal symptoms, left bundle branch block (LBBB), sever left ventricle (LV) dysfunction and male gender. At logistic analysis, the presence of LBBB (OR=6.63; 95% CI: 1.09-40) was significantly associated with outcome of death.Conclusion:The present study provides evidence that presence of LBBB, abnormal EP study result and structural heart disease (SHD) have prognostic value in patients with suspected cardiac cause of syncope. The patients with SHD and unexplained syncope who had a negative EP study have a good long-term prognosis even in the presence of LV dysfunction.

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“…Generally in patients with a normal physical examination, normal ECG and without familial history of sudden cardiac death and structural heart disease and negative tilt testing, the implantation of ICM must be considered early in the presence of recurrent syncope. Selective use of an electrophysiological study and tilt testing must be discussed before implanting the ICM (Garcia-Civera et al, 2003). In the presence of cardiac disease or high risk criteria suggesting arrhythmic syncope as defined in the 2009 guidelines, it is recommended to implant ICM after performing an electrophysiological study and tilt testing (Moya et al, 2009).…”

Section: Icm In Diagnosis and Management Of Syncope: Theory And Practicementioning

confidence: 99%