Mechanism of syncope without prodromes with normal heart and normal electrocardiogram.
Heart Rhythm
; 14(2): 234-239, 2017 02.
Article
in En
| MEDLINE
| ID: mdl-27639455
ABSTRACT
BACKGROUND:
"Unexplained syncope, no prodromes, and normal heart" has been described as a distinct clinical and biological entity.OBJECTIVE:
The purpose of this study was to assess the mechanism of syncope.METHODS:
In this prospective multicenter study, 58 patients presenting with unexplained syncope, no prodromes, and a normal heart received an implantable loop recorder (ILR) and were followed up until a diagnosis was established. Their outcomes were compared with those of 389 patients affected by reflex syncope with prodromes who received an ILR.RESULTS:
During a mean observation period of 16 ± 13 months, a diagnostic event was documented by the ILR in 29 patients (50%); an asystolic pause of 11 ± 5 seconds (range 3.5-22 seconds) was present at the time of the diagnostic event in 19 patients (66%). Compared with patients affected by reflex syncope with prodromes, patients with unexplained syncope, no prodromes, and a normal heart more frequently had an asystolic syncope (66% vs 47%; P = .001), and this was more frequently due to idiopathic paroxysmal atrioventricular block (47% vs 21%; P = .04). Ten patients with asystolic pauses underwent cardiac pacing, and 8 patients underwent oral theophylline treatment. During the subsequent 17 ± 12 months of follow-up, syncope recurred in 1 patient on theophylline and presyncope occurred in 1 patient with pacemaker.CONCLUSION:
A long asystolic pause, frequently due to idiopathic paroxysmal atrioventricular block, played a role in the mechanism of syncope in two-thirds of patients who had electrocardiographic documentation of a diagnostic event. When a specific therapy was administered in patients with asystolic syncope, the short outcome was favorable.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Syncope
/
Theophylline
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Cardiac Pacing, Artificial
/
Atrioventricular Block
/
Heart Arrest
Type of study:
Clinical_trials
/
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
/
Risk_factors_studies
Limits:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
Heart Rhythm
Year:
2017
Document type:
Article