Skip to main content

Unexplained Syncope with Inducible Sustained Ventricular Arrhythmias: to Implant or Not to Implant an ICD?

  • Conference paper
Cardiac Arrhythmias 2001
  • 71 Accesses

Zusammenfassung

The induction of a sustained ventricular arrhythmia in patients with otherwise unexplained syncope is generally regarded as an important finding with an unfavorable prognosis that deserves aggressive treatment with an implantable cardioverter-defibrillator (ICD). However, the real significance of an induced arrhythmia in patients with syncope of unknown origin varies greatly according to different factors, especially the programmed stimulation protocol used, the type of arrhythmia induced, and the patient characteristics, in particular the presence, type, and severity of underlying heart disease.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Raviele A, Di Pede F, Piccolo E (1985) Protocollo di studio elettrofarmacologico seria-to per la scelta della terapia antiaritmica cronica più efficace nei pazienti con tachi-cardie ventricolari sostenute e ricorrenti e nei soprawissuti ad un arresto cardiaco secondario a tachiaritmie ventricolari. G Ital Cardiol 15/1:354–357

    CAS  PubMed  Google Scholar 

  2. Bigger JT, Reiffei JA, Livelli FD, Wang PJ (1986) Sensitivity, specificity, and reproducibility of programmed ventricular stimulation. Circulation 73[Suppl II]:73–78

    Google Scholar 

  3. Morady F, Di Carlo L, Winston S et al (1984) A prospective comparison of triple extrastimuli and left ventricular stimulation in studies of ventricular tachycardia induction. Circulation 70:52–57

    Article  CAS  PubMed  Google Scholar 

  4. Brugada P, Green M, Abdollah H, Wellens HJJ (1984) Significance of ventricular arrhythmias initiated by programmed ventricular stimulation: the importance of the type of ventricular arrhythmia induced and the number of premature stimuli required. Circulation 69:87–92

    Article  CAS  PubMed  Google Scholar 

  5. Morady F, Shen E, Schwartz A et al (1983) Long-term follow-up of patients with recurrent unexplained syncope evaluated by electrophysiologic testing. J Am Coll Cardiol 2:1053–1059

    Article  CAS  PubMed  Google Scholar 

  6. Doherty JU, Pembrook-Rogers D, Grogane EW et al (1985) Electrophysiologic evaluation and follow-up characteristic of patients with recurrent unexplained syncope and presyncope. Am J Cardiol 55:703–708

    Article  CAS  PubMed  Google Scholar 

  7. Olshansky B, Mazuz M, Martins JB (1985) Significance of inducible tachycardia in patients with syncope of unknown origin: a long-term follow-up. J Am Coll Cardiol 5:216–223

    Article  CAS  PubMed  Google Scholar 

  8. Krol RB, Morady F, Flaker GC et al (1987) Electrophysiologic testing in patients with unexplained syncope: clinical and noninvasive predictors of outcome. J Am Coll Cardiol 10:358–363

    Article  CAS  PubMed  Google Scholar 

  9. Bass EB, Elson JJ, Fogoros RN et al (1988) Long-term prognosis of patients undergoing electrophysiologic studies for syncope of unknown origin. Am J Cardiol 62:1186–1191

    Article  CAS  PubMed  Google Scholar 

  10. Haïssaguerre M, Commenges D, Mathio JL et al (1989) Electrophysiologic study of syncope. Prediction of results. Presse Med 18:212–214

    PubMed  Google Scholar 

  11. Linzer M, Prystowsky EN, Divine GW et al (1991) Predicting the outcomes of electrophysiologic studies of patients with unexplained syncope: preliminary validation of a derived model. J Gen Intern Med 6:113–120

    Article  CAS  PubMed  Google Scholar 

  12. Bachinsky WB, Linzer M, Weld L, Estes NAM III (1992) Usefulness of clinical characteristics in predicting the outcome of electrophysiologic studies in unexplained syncope. Am J Cardiol 69:1044–1049

    Article  CAS  PubMed  Google Scholar 

  13. Winters SL, Stewart D, Gomes JA (1987) Signal averaging at the surface QRS complex predicts inducibility of ventricular tachycardia in patients with syncope of unknown origin: a prospective study. J Am Coll Cardiol 10:775–781

    Article  CAS  PubMed  Google Scholar 

  14. Link MS, Kim KMS, Homoud MK et al (1999) Long-term outcome of patients with syncope associated with coronary artery disease and a nondiagnostic electrophysiologic evaluation. Am J Cardiol 83:1334–1337

    Article  CAS  PubMed  Google Scholar 

  15. Raviele A (1991) Aritmie ventricolari nella cardiomiopatia dilatativa. Significato clinico-prognostico e ruolo délia stimolazione elettrica programmata. G Ital Cardiol 21:87–93

    CAS  PubMed  Google Scholar 

  16. Middlekauff HR, Stevenson WG, Stevenson LW, Saxon LA (1993) Syncope in advanced heart failure: high risk of sudden death regardless of origin of syncope. J Am Coll Cardiol 21:100–116

    Article  Google Scholar 

  17. Grimm W, Hoffmann J, Menz V et al (1998) Programmed ventricular stimulation for arrhythmia risk prediction in patients with idiopathic dilated cardiomyopathy and no sustained ventricular tachycardia. J Am Coll Cardiol 32:739–745

    Article  CAS  PubMed  Google Scholar 

  18. Knight BP, Goyal R, Pelosi F et al (1999) Outcome of patients with nonischemic dilated cardiomyopathy and unexplained syncope treated with an implantable defibrillator. J Am Coll Cardiol 33:1964–1970

    Article  CAS  PubMed  Google Scholar 

  19. Kuck KH (1997) Arrhythmias in hypertrophic cardiomyopathy. Pacing Clin Electrophysiol 20:2706–2713

    Article  CAS  PubMed  Google Scholar 

  20. Zhu DWX, Sun H, Hill R, Roberts R (1998) The value of electrophysiology study and prophylactic implantation of cardioverter defibrillator in patients with hypertrophic cardiomyopathy. Pacing Clin Electrophysiol 21:299–302

    Article  CAS  PubMed  Google Scholar 

  21. Fananapazir L, Epstein SE (1991) Value of electrophysiologic studies in hypertrophic cardiomyopathy treated with amiodarone. Am J Cardiol 67:175–182

    Article  CAS  PubMed  Google Scholar 

  22. Primo J, Geelen P, Brugada J et al (1998) Hypertrophic cardiomyopathy: role of the implantable cardioverter-defibrillator. J Am Coll Cardiol 31:1081–1085

    Article  CAS  PubMed  Google Scholar 

  23. Martinez-Rubio A, Schwammenthal Y, Schwammenthal E et al (1997) Patients with valvular heart disease presenting with sustained ventricular tachyarrhythmias or syncope. Circulation 96:500–508

    Article  CAS  PubMed  Google Scholar 

  24. Morady F, Shen E, Bhandari A et al (1984) Programmed ventricular stimulation in mitral valve prolapse: analysis of 36 patients. Am J Cardiol 53:135–138

    Article  CAS  PubMed  Google Scholar 

  25. Morady F, Higgins J, Peters RW et al (1984) Electrophysiologic testing in bundle branch block and unexplained syncope. Am J Cardiol 54:587–591

    Article  CAS  PubMed  Google Scholar 

  26. Englund A, Bergfeldt L, Rehnqvist N et al (1995) Diagnostic value of programmed ventricular stimulation in patients with bifascicular block: a prospective study of patients with and without syncope. J Am Coll Cardiol 26:1508–1515

    Article  CAS  PubMed  Google Scholar 

  27. Corrado D, Basso C, Thiene G (2000) Arrhythmogenic right ventricular cardiomyopathy: diagnosis, prognosis and treatment. Heart 83:588–595

    Article  CAS  PubMed  Google Scholar 

  28. Bhandari AK, Shapiro WA, Morady F et al (1985) Electrophysiologic testing in patients with the long QT syndrome. Circulation 71:63–71

    Article  CAS  PubMed  Google Scholar 

  29. Brugada J, Brugada R, Brugada P (1998) Right bundle-branch block and ST-segment elevation in leads VI through V3. Circulation 97:457–460

    Article  CAS  PubMed  Google Scholar 

  30. Priori SG, Napolitano C, Gasparini M et al (2000) Clinical and genetic heterogeneity of right bundle branch block and ST-segment elevation syndrome. Circulation 102:2509–2515

    Article  CAS  PubMed  Google Scholar 

  31. Gulamhusein S, Naccarelli GV, Ko PT et al (1982) Value and limitations of clinical electrophysiologic study in assessment of patients with unexplained syncope. Am J Med 73:700–705

    Article  CAS  PubMed  Google Scholar 

  32. Silka MJ, Kron J, Cutler JE, McAnulty JH (1990) Analysis of programmed stimulation methods in the evaluation of ventricular arrhythmias in patients 20 years old and younger. Am J Cardiol 66:826–830

    Article  CAS  PubMed  Google Scholar 

  33. Militianu A, Salacata A, Seibert K et al (1997) Implantable cardioverter defibrillator utilization among device recipients presenting exclusively with syncope or near-syncope. J Cardiovasc Electrophysiol 8:1087–1097

    Article  CAS  PubMed  Google Scholar 

  34. Link MS, Costeas XF, Griffith JL et al (1997) High incidence of appropriate implantable cardioverter-defibrillator therapy in patients with syncope of unknown etiology and inducible ventricular arrhythmias. J Am Coll Cardiol 29:370–375

    Article  CAS  PubMed  Google Scholar 

  35. Mittal S, Iwai S, Stein KM et al (1999) Long-term outcome of patients with unexplained syncope treated with an electrophysiologic-guided approach in the implantable cardioverter-defibrillator era. J Am Coll Cardiol 34:1082–1089

    Article  CAS  PubMed  Google Scholar 

  36. Andrews NP, Fogel RI, Pelargonio G et al (1999) Implantable defibrillator event rates in patients with unexplained syncope and inducible sustained ventricular tachyarrhythmias. J Am Coll Cardiol 34:2023–2030

    Article  CAS  PubMed  Google Scholar 

  37. Pires LA, May LM, Ravi S et al (2000) Comparison of event rates and survival in patients with unexplained syncope without documented ventricular tachyarrhythmias versus patients with documented sustained ventricular tachyarrhythmias both treated with implantable cardioverter-defibrillators. Am J Cardiol 85:725–728

    Article  CAS  PubMed  Google Scholar 

  38. Menon V, Steinberg JS, Akiyama T et al (2000) Implantable cardioverter defibrillator discharge rates in patients with unexplained syncope, structural heart disease, and inducible ventricular tachycardia at electrophysiologic study. Clin Cardiol 23:195–200

    Article  CAS  PubMed  Google Scholar 

  39. Domanski MJ, Saksena S, Epstein AE et al (1999) Relative effectiveness of the implantable cardioverter-defibrillator and antiarrhythmic drugs in patients with varying degrees of left ventricular dysfunction who have survived malignant ventricular arrhythmias. J Am Coll Cardiol 34:1090–1095

    Article  CAS  PubMed  Google Scholar 

  40. Sheldon R, Connolly S, Krahn A et al (2000) Identification of patients most likely to benefit from implantable cardioverter-defibrillator therapy. Circulation 101:1660–1664

    Article  CAS  PubMed  Google Scholar 

  41. Fonarow GC, Feliciano Z, Boyle NG et al (2000) Improved survival in patients with nonischemic advanced heart failure and syncope treated with an implantable cardioverter-defibrillator. Am J Cardiol 85:981–985

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2002 Springer-Verlag Italia

About this paper

Cite this paper

Raviele, A. (2002). Unexplained Syncope with Inducible Sustained Ventricular Arrhythmias: to Implant or Not to Implant an ICD?. In: Raviele, A. (eds) Cardiac Arrhythmias 2001. Springer, Milano. https://doi.org/10.1007/978-88-470-2103-7_10

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-2103-7_10

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-2165-5

  • Online ISBN: 978-88-470-2103-7

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics