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(Circulation. 1995;92:1332-1335.)
© 1995 American Heart Association, Inc.

Articles

Electrophysiological Testing

The Final Court of Appeal for Diagnosis of Syncope?

George J. Klein, MD; Bernard J. Gersh, MBCLB DPhil; Raymond Yee, MD

From the Department of Medicine, University of Western Ontario, London, Ontario, Canada, and the Cardiology Division, Georgetown University Medical Center, Washington, DC, USA.

Correspondence to Dr George J. Klein, University Hospital, 339 Windermere Rd, London, Ontario, Canada N6A 5A5.

Key Words: diagnosis • electrophysiology • tachyarrhythmias • syncope

	Introduction

 
Unexplained syncope is a relatively frequent cause of admission to emergency departments, and it continues to pose a clinical dilemma, despite the development of new diagnostic techniques.^{1 2 3 4 5 6} For the patient, the syndrome is a source of morbidity and, to a lesser extent, mortality. Recurrences may have a substantial and deleterious effect on lifestyle, the sense of physical well-being, and employment opportunities. Understandably, the search for treatable or preventable causes and identification of cost-effective approaches to syncope continue to remain a focus of clinical interest.

	Diagnostic Evaluation

 
The cause of a syncopal episode is frequently problematic if the diagnosis is not evident after the initial clinical and laboratory assessment.^{1 2 3 4 5 6} The major obstacle to diagnosis is the periodic and unpredictable frequency of events, with months and years separating spells and a high spontaneous remission rate.⁷ This creates a prohibitive barrier for recording of the ECG during a spontaneous episode in most patients, and even aggressive and prolonged ECG monitoring may yield only a 16% diagnosis rate over a 6-month period.⁵ Perhaps the most valuable clinical tools for the diagnosis of syncope are the clinical history and, in some patients, the use of additional tests to identify structural heart disease. An abnormal ECG frequently is present in patients with syncope but rarely identifies the specific cause. Prolonged ambulatory monitoring has been used widely as a diagnostic tool, but most frequently it identifies nonspecific arrhythmias in the absence of symptoms. Despite the widespread acceptance of ambulatory monitoring as a key aspect of our diagnostic armamentarium for . . . [Full Text of this Article]

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