Diagnostic work-up for syncope in the elderly: standard parameters, complications and results of electrophysiologic studies

Invasive electrophysiologic study (EPS) is an important tool in the assessm ent of patients with unexplained syncope. Especially in the elderly, the ne ed for a complete diagnostic work-up is counterbalanced by the fear of comp lications associated with invasive procedures. Thus, the present study specifically addressed the question whether the ris k/benefit ratio of EPS in geriatric patients with unexplained syncope justi fies this invasive procedure. An invasive EPS was performed in 96 patients between 70 and 80 years and 21 patients older than 80 years. The control group consisted of 65 patients y ounger than 40 years. With increasing age, the diagnostic yield of EPS also increased (positive EPS finding in 20% of the control group and in 54% of the eldest patients). The majority of complications were of minor clinical significance and no significant differences were found between the three gr oups. Finally, no age-related difference in measured standard electrophysio logical parameters was evident. Due to the high diagnostic value and the low complication rate, EPS can be recommended in elderly patients with unexplained syncope. An age-specific standardization of electrophysiologic parameters, measured during EPS, does not seem to be required.