Long-term outcome of patients with syncope associated with coronary artery disease and a nondiagnostic electrophysiologic evaluation

Mark S. Link, Kyong Mee S Kim, Munther K. Homoud, N. A Mark Estes, Paul J. Wang

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

Syncope in the patient with structural heart disease and a nondiagnostic noninvasive workup is a generally accepted indication for an invasive electrophysiologic study. However, if the electrophysiologic evaluation is not highly sensitive, arrhythmic causes of syncope may not be discovered. In these patients, recurrent syncope and even sudden death may be observed at follow-up. Thus, we evaluated long-term follow-up in 68 consecutive patients who presented with syncope, coronary artery disease, and who had a negative invasive electrophysiologic evaluation. At a mean follow-up of 30 ± 18 months (range 1 to 65), there have been 2 sudden deaths and 1 episode each of ventricular fibrillation and ventricular tachycardia in patients treated with an implantable cardioverter-defibrillator. All 4 arrhythmias occurred in patients with left ventricular fractions ≤25%. Seventeen patients had recurrent presyncope or syncope. Bradycardia causing syncope was found in 8 of these patients. A bundle branch block at the initial evaluation predicted for the occurrence of bradycardia at follow-up. We conclude that in patients with coronary artery disease and syncope, noninducibility at electrophysiologic study predicts a lower risk of sudden death and ventricular arrhythmias. However, in patients with a reduced ejection fraction, the risk of sudden death and ventricular arrhythmias remains up to 10%/year and these patients may warrant treatment with implantable cardioverter-defibrillators. Recurrent syncope is common, and frequently a bradyarrhythmia is found to be the cause. Treatment of selected patients (especially those with bundle branch blocks) with permanent pacemakers may be justified.

Original languageEnglish (US)
Pages (from-to)1334-1337
Number of pages4
JournalAmerican Journal of Cardiology
Volume83
Issue number9
DOIs
StatePublished - May 1 1999

Fingerprint

Syncope
Coronary Artery Disease
Sudden Death
Bradycardia
Cardiac Arrhythmias
Bundle-Branch Block
Implantable Defibrillators
Ventricular Fibrillation
Ventricular Tachycardia
Heart Diseases

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Long-term outcome of patients with syncope associated with coronary artery disease and a nondiagnostic electrophysiologic evaluation. / Link, Mark S.; Kim, Kyong Mee S; Homoud, Munther K.; Estes, N. A Mark; Wang, Paul J.

In: American Journal of Cardiology, Vol. 83, No. 9, 01.05.1999, p. 1334-1337.

Research output: Contribution to journalArticle

Link, Mark S. ; Kim, Kyong Mee S ; Homoud, Munther K. ; Estes, N. A Mark ; Wang, Paul J. / Long-term outcome of patients with syncope associated with coronary artery disease and a nondiagnostic electrophysiologic evaluation. In: American Journal of Cardiology. 1999 ; Vol. 83, No. 9. pp. 1334-1337.
@article{883fbf1450c14bc99d1d316fa5d0c45b,
title = "Long-term outcome of patients with syncope associated with coronary artery disease and a nondiagnostic electrophysiologic evaluation",
abstract = "Syncope in the patient with structural heart disease and a nondiagnostic noninvasive workup is a generally accepted indication for an invasive electrophysiologic study. However, if the electrophysiologic evaluation is not highly sensitive, arrhythmic causes of syncope may not be discovered. In these patients, recurrent syncope and even sudden death may be observed at follow-up. Thus, we evaluated long-term follow-up in 68 consecutive patients who presented with syncope, coronary artery disease, and who had a negative invasive electrophysiologic evaluation. At a mean follow-up of 30 ± 18 months (range 1 to 65), there have been 2 sudden deaths and 1 episode each of ventricular fibrillation and ventricular tachycardia in patients treated with an implantable cardioverter-defibrillator. All 4 arrhythmias occurred in patients with left ventricular fractions ≤25{\%}. Seventeen patients had recurrent presyncope or syncope. Bradycardia causing syncope was found in 8 of these patients. A bundle branch block at the initial evaluation predicted for the occurrence of bradycardia at follow-up. We conclude that in patients with coronary artery disease and syncope, noninducibility at electrophysiologic study predicts a lower risk of sudden death and ventricular arrhythmias. However, in patients with a reduced ejection fraction, the risk of sudden death and ventricular arrhythmias remains up to 10{\%}/year and these patients may warrant treatment with implantable cardioverter-defibrillators. Recurrent syncope is common, and frequently a bradyarrhythmia is found to be the cause. Treatment of selected patients (especially those with bundle branch blocks) with permanent pacemakers may be justified.",
author = "Link, {Mark S.} and Kim, {Kyong Mee S} and Homoud, {Munther K.} and Estes, {N. A Mark} and Wang, {Paul J.}",
year = "1999",
month = "5",
day = "1",
doi = "10.1016/S0002-9149(99)00096-X",
language = "English (US)",
volume = "83",
pages = "1334--1337",
journal = "American Journal of Cardiology",
issn = "0002-9149",
publisher = "Elsevier Inc.",
number = "9",

}

TY - JOUR

T1 - Long-term outcome of patients with syncope associated with coronary artery disease and a nondiagnostic electrophysiologic evaluation

AU - Link, Mark S.

AU - Kim, Kyong Mee S

AU - Homoud, Munther K.

AU - Estes, N. A Mark

AU - Wang, Paul J.

PY - 1999/5/1

Y1 - 1999/5/1

N2 - Syncope in the patient with structural heart disease and a nondiagnostic noninvasive workup is a generally accepted indication for an invasive electrophysiologic study. However, if the electrophysiologic evaluation is not highly sensitive, arrhythmic causes of syncope may not be discovered. In these patients, recurrent syncope and even sudden death may be observed at follow-up. Thus, we evaluated long-term follow-up in 68 consecutive patients who presented with syncope, coronary artery disease, and who had a negative invasive electrophysiologic evaluation. At a mean follow-up of 30 ± 18 months (range 1 to 65), there have been 2 sudden deaths and 1 episode each of ventricular fibrillation and ventricular tachycardia in patients treated with an implantable cardioverter-defibrillator. All 4 arrhythmias occurred in patients with left ventricular fractions ≤25%. Seventeen patients had recurrent presyncope or syncope. Bradycardia causing syncope was found in 8 of these patients. A bundle branch block at the initial evaluation predicted for the occurrence of bradycardia at follow-up. We conclude that in patients with coronary artery disease and syncope, noninducibility at electrophysiologic study predicts a lower risk of sudden death and ventricular arrhythmias. However, in patients with a reduced ejection fraction, the risk of sudden death and ventricular arrhythmias remains up to 10%/year and these patients may warrant treatment with implantable cardioverter-defibrillators. Recurrent syncope is common, and frequently a bradyarrhythmia is found to be the cause. Treatment of selected patients (especially those with bundle branch blocks) with permanent pacemakers may be justified.

AB - Syncope in the patient with structural heart disease and a nondiagnostic noninvasive workup is a generally accepted indication for an invasive electrophysiologic study. However, if the electrophysiologic evaluation is not highly sensitive, arrhythmic causes of syncope may not be discovered. In these patients, recurrent syncope and even sudden death may be observed at follow-up. Thus, we evaluated long-term follow-up in 68 consecutive patients who presented with syncope, coronary artery disease, and who had a negative invasive electrophysiologic evaluation. At a mean follow-up of 30 ± 18 months (range 1 to 65), there have been 2 sudden deaths and 1 episode each of ventricular fibrillation and ventricular tachycardia in patients treated with an implantable cardioverter-defibrillator. All 4 arrhythmias occurred in patients with left ventricular fractions ≤25%. Seventeen patients had recurrent presyncope or syncope. Bradycardia causing syncope was found in 8 of these patients. A bundle branch block at the initial evaluation predicted for the occurrence of bradycardia at follow-up. We conclude that in patients with coronary artery disease and syncope, noninducibility at electrophysiologic study predicts a lower risk of sudden death and ventricular arrhythmias. However, in patients with a reduced ejection fraction, the risk of sudden death and ventricular arrhythmias remains up to 10%/year and these patients may warrant treatment with implantable cardioverter-defibrillators. Recurrent syncope is common, and frequently a bradyarrhythmia is found to be the cause. Treatment of selected patients (especially those with bundle branch blocks) with permanent pacemakers may be justified.

UR - http://www.scopus.com/inward/record.url?scp=0033135527&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033135527&partnerID=8YFLogxK

U2 - 10.1016/S0002-9149(99)00096-X

DO - 10.1016/S0002-9149(99)00096-X

M3 - Article

C2 - 10235091

AN - SCOPUS:0033135527

VL - 83

SP - 1334

EP - 1337

JO - American Journal of Cardiology

JF - American Journal of Cardiology

SN - 0002-9149

IS - 9

ER -