Syncope: complications were rare from electrophysiologic studies.

Clinical bottom line (level 2c)

  1. A fifth of patients having electrophysiologic studies needed cardioversion out of induced arrhythmias.
  2. Other complications were rare.
Horowitz et al: Journal of the American College of Cardiology 1987; 9 (6): 1261-1268
Expires October 2004

The study

Outcome study with ?objective ?blinded outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: university cardiovascular unit, USA

1000 patients (aged range 16 to 84 years; mean 58, 73% male) having electrophysiologic studies (44% for episodes of ventricular tachycardia, 18% for cardiac arrest, 18% for syncope, 7% for paroxysmal SVT, 7% unknown tachycardia, 7% AV conduction disturbance)


100% followed for 7 days
Outcomes studied:
  • death
  • vascular complications thrombosis, dissection, rupture, malformation, haematoma
  • embolic complication stroke, MI, peripheral emboli, DVT, PE
  • cardiac perforation echo indicating blood in pericardial space
  • hypotension within 24 hours and not responding to raising legs or infusion of 250 ml saline
  • arrhythmia > 6 hours post study or requiring treatment
  • cardioversion to terminate induced arrhythmia

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    death 7 days 1/1000 0.10%
    (0.00% to 0.30%)
    vascular complications 7 days 12/1000 1.2%
    (0.53% to 1.9%)
    embolic complication 7 days 4/1000 0.40%
    (0.009% to 0.79%)
    cardiac perforation 7 days 2/1000 0.20%
    (0.00% to 0.48%)
    hypotension 7 days 20/1000 2.0%
    (1.1% to 2.9%)
    arrhythmia 7 days 19/1000 1.9%
    (1.1% to 2.8%)
    cardioversion 7 days 217/1000 21.7%
    (19.1% to 24.3%)

    • Three PEs, two haematomas, four arterial dissections or ruptures.

    Citation

    1. Horowitz LN, Kay HR, Kutalek SP, et al: Risks and complications of clinical cardiac electrophysiologic studies: a prospective analysis of 1,000 consecutive patients. Journal of the American College of Cardiology 1987; 9 (6): 1261-1268
    Contributor: Chris Ball and Clare Wotton, October 2000
    Reviewer:

    Clinical Question.
    Patient having electrophysiologic studies
    Intervention or Exposure prevalence
    Outcome complications