Mechanism of syncope without prodromes with normal heart and normal electrocardiogram
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- 作者：Michele Brignole ; MD* ; mbrignole@asl4.liguria.it ; Regis Guieu ; MD&dagger ; ; Marco Tomaino ; MD&Dagger ; ; Matteo Iori ; MD§ ; ; Andrea Ungar ; MD║ ; Cristina Bertolone ; RN* ; Matthias Unterhuber ; MD&Dagger ; ; Nicola Bottoni ; MD§ ; ; Francesca Tesi ; MD║ ; Jean Claude Deharo ; MD¶ ;
- 关键词：Syncope ; Adenosine ; Implantable loop recorder ; Cardiac pacing ; Theophylline
- 刊名：Heart Rhythm
- 出版年：2017
- 出版时间：February 2017
- 年：2017
- 卷：14
- 期：2
- 页码：234-239
- 全文大小：567 K
- 卷排序：14
文摘
“Unexplained syncope, no prodromes, and normal heart” has been described as a distinct clinical and biological entity.ObjectiveThe purpose of this study was to assess the mechanism of syncope.MethodsIn 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.ResultsDuring 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.ConclusionA 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.