open access

Vol 16, No 4 (2009)
Original articles
Published online: 2009-05-12
Submitted: 2013-01-14
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Predictors of ventricular tachycardia induction in syncopal patients with mild to moderate left ventricular dysfunction

Amir Farjam Fazelifar, Peyman Ashrafi, Majid Haghjoo, Zahra Ojaghi Haghighi, Hooman Bakhshandeh Abkenar, Ashrafossadat Ashour, Shahrbanou Azari, Azam Forghanian, Mohammad Ali Sadr-Ameli
Cardiol J 2009;16(4):327-331.

open access

Vol 16, No 4 (2009)
Original articles
Published online: 2009-05-12
Submitted: 2013-01-14

Abstract

Background: In patients with mild to moderate left ventricular dysfunction (LVD) (35% £ LVEF £ 50%) who present with syncope, demonstration of tachy and/or brady-arrhythmia has prognostic value. In this group of patients electrophysiological study (EPS) is often necessary.
Methods: A total of 53 consecutive patients with mild to moderate LVD and history of undetermined syncope underwent EPS. Sinus node function, His-Purkinje system conduction and ventricular electrical stability were evaluated.
Results: Twenty eight patients (52.8%) had induction of sustained monomorphic ventricular tachycardia (VT) and five (9.4%) patients had a sustained ventricular arrhythmia other than monomorphic VT (ventricular flutter, ventricular fibrillation, and polymorphic VT) induced during EPS. Abnormal sinus node function and/or His-Purkinje system conduction was found in five (9.4%) patients. Age, gender, history of myocardial infarction, type of underlying heart disease and history of revascularization were not predictors of VT induction. Wide QRS morphology independently, and lower left ventricular ejection fraction and presence of pathologic q wave in precordial leads dependently, could increase risk of VT induction.
Conclusions: The EPS can determine which patient with syncope and mild to moderate LVD is likely to benefit from placing an ICD for prevention of sudden cardiac death. Pathologic precordial q wave, wide QRS morphology and lower left ventricular ejection fraction could be predictors of VT induction during EPS. Wide QRS morphology has an independent effect in this category.

Abstract

Background: In patients with mild to moderate left ventricular dysfunction (LVD) (35% £ LVEF £ 50%) who present with syncope, demonstration of tachy and/or brady-arrhythmia has prognostic value. In this group of patients electrophysiological study (EPS) is often necessary.
Methods: A total of 53 consecutive patients with mild to moderate LVD and history of undetermined syncope underwent EPS. Sinus node function, His-Purkinje system conduction and ventricular electrical stability were evaluated.
Results: Twenty eight patients (52.8%) had induction of sustained monomorphic ventricular tachycardia (VT) and five (9.4%) patients had a sustained ventricular arrhythmia other than monomorphic VT (ventricular flutter, ventricular fibrillation, and polymorphic VT) induced during EPS. Abnormal sinus node function and/or His-Purkinje system conduction was found in five (9.4%) patients. Age, gender, history of myocardial infarction, type of underlying heart disease and history of revascularization were not predictors of VT induction. Wide QRS morphology independently, and lower left ventricular ejection fraction and presence of pathologic q wave in precordial leads dependently, could increase risk of VT induction.
Conclusions: The EPS can determine which patient with syncope and mild to moderate LVD is likely to benefit from placing an ICD for prevention of sudden cardiac death. Pathologic precordial q wave, wide QRS morphology and lower left ventricular ejection fraction could be predictors of VT induction during EPS. Wide QRS morphology has an independent effect in this category.
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Keywords

syncope; left ventricular dysfunction; electrophysiology study

About this article
Title

Predictors of ventricular tachycardia induction in syncopal patients with mild to moderate left ventricular dysfunction

Journal

Cardiology Journal

Issue

Vol 16, No 4 (2009)

Pages

327-331

Published online

2009-05-12

Bibliographic record

Cardiol J 2009;16(4):327-331.

Keywords

syncope
left ventricular dysfunction
electrophysiology study

Authors

Amir Farjam Fazelifar
Peyman Ashrafi
Majid Haghjoo
Zahra Ojaghi Haghighi
Hooman Bakhshandeh Abkenar
Ashrafossadat Ashour
Shahrbanou Azari
Azam Forghanian
Mohammad Ali Sadr-Ameli

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