Circulation. 2001;104:1261-1267
doi: 10.1161/hc3601.095708
doi: 10.1161/hc3601.095708
(Circulation. 2001;104:1261.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Mechanism of Syncope in Patients With Isolated Syncope and in Patients With Tilt-Positive Syncope
From the Departments of Cardiology of Hospital Vall d’Hebron, Barcelona, Spain (A.M.); Ospedali Riuniti, Lavagna, Italy (M.B.); Ospedale S Maria Nuova, Reggio Emilia, Italy (C.M.); Hospital Clinico Universitario, Valencia, Spain (R.G.-C.); Ospedale Villa Maria, Piombino, Italy (S.T.); Hospital Clinico, Barcelona, Spain (L.M.); Ospedale Umberto I, Mestre, Italy (F.G.); Ospedale S. Anna, Como, Italy (G.B.); Ospedale per gli Infermi, Faenza, Italy (D.C.).
Correspondence to Michele Brignole, MD, Department of Cardiology, Ospedali Riuniti, I-16032 Lavagna, Italy. E-mail mbrignole{at}ASL4.liguria.it
Background— Because of its episodic behavior, the correlation of spontaneous syncope with an abnormal finding can be considered a reference standard.
Methods and Results— We inserted an implantable loop recorder in 111 patients with syncope, absence of significant structural heart disease, and a normal ECG; tilt-testing was negative in 82 (isolated syncope) and positive in 29 (tilt-positive). The patients had had 
3 episodes of syncope in the previous 2 years and were followed up for 3 to 15 months. Results were similar in the isolated syncope group and the tilt-positive group: syncope recurred in 28 (34%) and 10 patients (34%), respectively, and electrocardiographic correlation was found in 24 (23%) and 8 (28%) patients, respectively. The most frequent finding, which was recorded in 46% and 62% of patients, respectively, was one or more prolonged asystolic pauses, mainly due to sinus arrest, preceded for a few minutes by progressive bradycardia or progressive tachycardia-bradycardia. Bradycardia without pauses was observed in 8% and 12% of cases, respectively. The remaining patients had normal sinus rhythm or sinus tachycardia, except for one, who had ectopic atrial tachycardia. In the tilt-positive group, an asystolic syncope was also recorded when the type of response to tilt-testing was vasodepressor or mixed. Presyncopal episodes were never characterized by asystolic pauses; normal sinus rhythm was the most frequent finding.
Conclusions— Homogeneous findings were observed during syncope. In most patients, the likely cause was neurally-mediated, and the most frequent mechanism was a bradycardic reflex. In the other cases, a normal sinus rhythm was frequently recorded. Presyncope was not an accurate surrogate for syncope in establishing a diagnosis.
Key Words: syncope • arrhythmia • diagnosis • electrocardiography
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