[Electrophysiological findings and follow-up in patients with syncope (author's transl)]

Abstract

92 patients (mean age 54 +/- 14.7 years, 54 men) with unexplained syncopes were investigated by Holter monitoring, exercise testing and His-bundle-electrography (high-rate and programmed atrial stimulation). The diagnoses on 43 patients were sinus node dysfunction, in 32 cases atrio and/or intraventricular block, and in 6 patients idiopathic atrial fibrillation, whereas 8 patients had a history of ventricular tachycardia, 48 patients received a pacemaker (mean age 58 +/- 12.9 years), and 44 patients were discharged without a pacemaker (mean age 49 +2- 15.6 years). The mean duration of follow-up was 56 +2- 17.1 months. There were 13 deaths, 9 patients died from heart failure, 1 died suddenly, and 3 patients died from non-cardiac causes. 7 patients were lost to follow-up. 54 patients had no syncope any longer, while in 18 cases syncope was still present, 14 patients without pacemaker and 4 patients with pacemaker still had attacks. The cardiac mortality was 18.8% (with pacemaker) and 2.3% (without pacemaker). The only sudden cardiac death was observed in a patient with pacemaker. This study shows that pacemaker implantation bases on electrophysiologic study is able to improve symptoms in patients with syncope. However, the long-term prognosis of the patients is mainly depending on the severity of their underlying heart disease.