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.
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References
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
Bigger JT, Reiffei JA, Livelli FD, Wang PJ (1986) Sensitivity, specificity, and reproducibility of programmed ventricular stimulation. Circulation 73[Suppl II]:73–78
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
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
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
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
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
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
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
Haïssaguerre M, Commenges D, Mathio JL et al (1989) Electrophysiologic study of syncope. Prediction of results. Presse Med 18:212–214
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
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
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
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
Raviele A (1991) Aritmie ventricolari nella cardiomiopatia dilatativa. Significato clinico-prognostico e ruolo délia stimolazione elettrica programmata. G Ital Cardiol 21:87–93
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
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
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
Kuck KH (1997) Arrhythmias in hypertrophic cardiomyopathy. Pacing Clin Electrophysiol 20:2706–2713
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
Fananapazir L, Epstein SE (1991) Value of electrophysiologic studies in hypertrophic cardiomyopathy treated with amiodarone. Am J Cardiol 67:175–182
Primo J, Geelen P, Brugada J et al (1998) Hypertrophic cardiomyopathy: role of the implantable cardioverter-defibrillator. J Am Coll Cardiol 31:1081–1085
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
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
Morady F, Higgins J, Peters RW et al (1984) Electrophysiologic testing in bundle branch block and unexplained syncope. Am J Cardiol 54:587–591
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
Corrado D, Basso C, Thiene G (2000) Arrhythmogenic right ventricular cardiomyopathy: diagnosis, prognosis and treatment. Heart 83:588–595
Bhandari AK, Shapiro WA, Morady F et al (1985) Electrophysiologic testing in patients with the long QT syndrome. Circulation 71:63–71
Brugada J, Brugada R, Brugada P (1998) Right bundle-branch block and ST-segment elevation in leads VI through V3. Circulation 97:457–460
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
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
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
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
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
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
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
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
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
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
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
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
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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
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DOI: https://doi.org/10.1007/978-88-470-2103-7_10
Publisher Name: Springer, Milano
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