Syncope: electrophysiologic studies were not very useful.

Clinical bottom line (level 4)

  1. Electrophysiologic studies detected few true causes of arrhythmia in patients with syncope and induced as many unrelated ones.
Fujimura et al: New England Journal of Medicine 1989; 321 (25): 1703-1707
Expires October 2004

The study

Setting: tertiary medical care centre, Canada

21 patients (aged range 45 to 80 years; mean 63, 66% male) angiographically documented intermittent, high-degree atrioventricular block (n=13) or sinus pauses (n=8) during syncope episodes
Patients continued the drugs they were already taking before syncope.
Independent ?blinded reference standard, applied in all patients from a consecutive appropriate spectrum.
Reference standard:
  • ECG documented bradyarrhythmia during syncopal episode (13 with intermittent AV block, 8 with sinus pauses)
Diagnostic test: two electrode catheters placed in high right atrium and right ventricle.
  • All patients had history and physical, routine blood test, urinalysis, CXR and exercise test if capable.

The evidence

  • arrhythmia detected by EPS: 5/21 (24%: 95% CI: 4.4% to 43%)
  • unrelated arrhythmia detected by EPS: 3/21 (14%: 95% CI: 0.0% to 30%)

Comments

  1. Study is small, giving wide confidence intervals, but suggests that the test characteristics of EPS should be studied in more depth, and its results treated with caution in the meantime.

Citation

  1. Fujimura O, Yee R, Klein GJ, et al: the diagnostic sensitivity of electrophysiologic testing in patients with syncope caused by transient bradycardia. New England Journal of Medicine 1989; 321 (25): 1703-1707
Contributor: Chris Ball and Clare Wotton, October 2000
Reviewer:

Clinical Question.
Patient syncope
Intervention or Exposure electrophysiologic studies
Outcome causes of arrhythmia