The combination of electrophysiologic evaluation and head-up tilt testing identified the underlying cause of syncope in 74% of patients presenting with unexplained syncope.
Observational (n=86)
No
Does a diagnostic strategy of electrophysiologic studies and head-up tilt testing identify the cause and prevent recurrence in patients with unexplained syncope?
Sequential evaluation with electrophysiologic studies and head-up tilt testing is highly effective in diagnosing unexplained syncope and guiding therapy to prevent recurrence.
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.
Jasbir et al. (1991) conducted an observational in Unexplained syncope (n=86). Electrophysiologic studies and head-up tilt testing was evaluated on Identification of underlying cause of syncope. The combination of electrophysiologic evaluation and head-up tilt testing identified the underlying cause of syncope in 74% of patients presenting with unexplained syncope.
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