Transoesophageal electrophysiological study: a simple method of investigation of unexplained malaises in elderly patients.

Cardiac arrhythmias are common causes of syncope and malaise in elderly pat ients, but they are sometimes difficult to demonstrate without invasive pro cedures. The aim of this report was to demonstrate the value of transoesoph ageal electrophysiological investigation in cases of negative classical non -invasive studies. The authors report 18 cases of patients, aged 70 to 88, mainly in poor gene ral condition, who were admitted for the investigation of malaise or syncop e. The ECC was normal or subnormal and Holter monitoring non-contributive t o the diagnosis. Transoesophageal electrophysiological study enabled initia tion of an arrhythmia, bradycardia or tachycardia, which reproduced the sym ptoms of spontaneous malaise. In 10 cases, paroxysmal junctional tachycardi a was demonstrated, by nodal reentry in 8 cases, and in a latent Kent bundl e in 2 cases. The malaise was caused by tachyarrhythmia in 3 patients and b y a vagal reaction or sinus arrest after the tachycardia in the other patie nts. In 6 other patients, atrial fibrillation reproduced the malaise either due to the rapid rhythm, or to bradycardia after the arrhythmia in 3 cases . In another 2 patients, conduction defects were demonstrated by atrial sti mulation (alternating bundle branch block in one patient, complete atrioven tricular block at the end of atrial stimulation in another patient). The authors conclude that transoesophageal electrophysiological study is a simple technique which allows diagnosis of unexplained malaise in elderly p atients when non-invasive methods are unable to demonstrate the causal arrh ythmia. Supraventricular arrhythmias seem to be a common and probably under estimated cause of malaise or syncope in elderly patients.