Copyright © 1989 by the European Society of Cardiology.
© 1989 The European Society of Cardiology
Long-term follow-up of patients with unexplained syncope and negative electrophysiologic study
Division of Cardiology, Hospital of Mestre Venice
*Division of Cardiology Hospital of Udine Italy
Received 2 February 1988; revised 17 June 1988; .
Address for correspondence: Dr Antonio Raviele, Division of Cardiology, Hospital of Mestre, 30175 Mestre (Venice), Italy.
Abstract
Fifty-eight patients (29 M, 29 F, mean age 60.8 ± 16 years) with unexplained syncope at the end of a complete clinical and electrophysiological evaluation, were followed for a mean period of 36.6 ± 20.5 months (median: 30.5 months).
Structural heart disease was present in 32 patients (55.2%). The standard ECG was normal in 24 (41.4%) and showed sinus bradycardia (>40m-1) and/or first degree AV block and/or intraventricular conduction disturbances in 29 patients (50%).
During follow-up, recurrences of syncope were observed in 11 of 43 untreated patients (25.6%), three of seven electrically treated patients (42.9%) and two of eight pharmacologically treated patients (25%). The cause of these recurrences was cardiac in one (1.7%), non-cardiac in 10 (17.2%) and remained undetermined in five (8.6%). Sudden death occurred in only one patient (1.7%), who was receiving chronic amiodarone therapy.
These results indicate that (1) syncopal recurrences may occur in an appreciable percentage of patients with unexplained syncope and a negative electrophysiologic study during a relatively long-term follow-up, (2) syncopal recurrences, when they occur, are generally due to a non-cardiac cause, (3) sudden death is an occasional and rare event in this patient population and (4) empirical prophylactic treatment with apermanent pacemaker or antiarrhythmic drugs does not usually prevent complications during the follow-up.
Key Words: Clinical electrophysiology • unexplained syncope
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