Aims Despite the large number of hospital admissions due to syncope, information on the in-hospital cost of management of these patients remains incomplete. Methods and results In order to assess such cost, we analysed the clinical histories of the patients suffering from syncope who were admitted to our Unit of Cardiology in 2003. We determined the length of stay (in days) for each inpatient, the number of diagnostic tests performed, and the various therapeutic procedures undertaken. Two hundred and three patients (mean age 68 +/- 14, 49% female) were admitted because of syncope. Final diagnoses on discharge were drug-induced syncope in 10 patients, vasovagal syncope in 11, syncope secondary to cardiac ischaemia in 18, valvular disease in 4, rapid supraventricular arrhythmia in 20, ventricular arrhythmia in 19, atrioventricular block in 90, and unexplained syncope in 31 patients. Of these 203 patients, 70 (34.5%) had a previous history of cardiac disease. The global cost for all 203 patients was 2 264 979EURO. The overall cost per patient was 11 158EURO (range: 1651-31 762) including stay, diagnosis, and treatment. The overall cost of hospital stay per patient was 3718EURO (range: 1436-5679). The overall cost per diagnosis of the 203 patients was 1141EURO (range: 155-3577), and the cost of the therapeutic procedures required was 6299EURO (range: 0-23 115). The most expensive were those cases of syncope secondary to ventricular arrhythmia, the cost of which is 20 times that of drug-induced syncope. Conclusion The cost per diagnosis and treatment of a patient admitted because of syncope varies widely with important differences depending on the specific cause.

Radiofrequency catheter ablation of a recurrent orthodromic tachycardia was performed in a 10-year-old child with single ventricle and bidirectional Glenn procedure before a Fontan operation. Identification of a His bundle electrogram was achieved at the postero-inferior atrioventricular (AV) groove by the inferior vena cava route, and electrophysiological demonstration of a concealed accessory pathway-mediated tachycardia was possible when a ventricular extrastimuli given during the His bundle refractoriness showed advancement of the atrium. A single energy application during tachycardia in the right antero-superior region of the AV groove resulted in the definitive interruption of the accessory pathway.

BACKGROUND AND OBJECTIVE:The prevalence and morbidity of the vaso-vagal syncope are well-known. With the intention of measuring the Quality of Life (QoL) of patients with vaso-vagal syncope, as well as age and gender influence, we have used the Spanish version of Short form 36 (SF-36) questionnaire in those patients and have compared it with the general population and with patients with heart failure.PATIENTS AND METHOD:All consecutive patients with vaso-vagal syncope submitted for head-up tilt test performance from January 2001 to December 2002 were included. SF-36 was self-administered prior to the head-up tilt test.RESULTS:Two hundred and seventy one patients were included (50.5% females). In these patients, QoL scores were lower than those of the Spanish general population and similar to those in patients with heart failure. Women's scores were lower in eight dimensions, and only four were lower in men's. Women QoL was worst than men's (p < 0.05). Age had a negative influence on the eight dimensions of SF-36, especially in women. The number of syncopes was the most influential clinic parameter on the QoL of such patients.CONCLUSIONS:In our series, patients suffering from vaso-vagal syncope had a poor QoL when compared with heart failure or control populations. Women had lower QoL than men, and there was an age-related worsening in both men and women. Our data show that the number of syncopes is the clinic parameter having the best correlation with QoL.

Because of the absence of a uniform protocol for the head-up tilt table test (HUT), we compared 1,661 consecutive patients with syncope referred for HUT. The influence of age and gender on the results (positive response rate and patterns) obtained with three different protocols, Westminster, isoprenaline and nitroglycerin (groups A, B and C) was analyzed. The proportion of women was larger in the youngest age group. A positive response to HUT was observed in 592 patients. The positive response rate to the HUT was higher in groups B and C than in group A, and the rate diminished with age in groups A and C, because of the decrease in mixed-positive responses, but not in group B. The rate of positive responses was similar in groups A and C, but different in group B; no influence of gender on these results was observed. The results with the Westminster and nitroglycerin protocols were similar, but the rate of positive responses was higher in the latter.

Son conocidas la prevalencia del síncope vasovagal y su morbilidad. Con objeto de cuantificar la calidad de vida relacionada con la salud (CVRS) de los pacientes que lo sufren y evaluar la influencia de la edad y el sexo, se compararon los resultados obtenidos tras la administración de la versión española del Cuestionario de Salud SF-36 en esta población con los valores de la población general y de pacientes con insuficiencia cardíaca. Además se ha analizado la influencia de diversos parámetros clínicos. Se incluyó consecutivamente a todos los pacientes con síncope vasovagal sometidos a test de tabla basculante desde enero de 2001 hasta diciembre de 2002. El cuestionario se contestó previamente a la realización del test. Se calcularon los valores utilizando estadísticos apropiados a la distribución de la muestra, se analizaron según la edad y el sexo, y se correlacionaron con diversos parámetros clínicos. Se incluyó a 271 pacientes (50,5% mujeres). La CVRS en estos pacientes fue inferior a los valores poblacionales y similar a la de los pacientes que sufren insuficiencia cardíaca. En el varón sólo 4 dimensiones del SF-36 fueron inferiores a la población general, y en la mujer lo fueron las 8. La mujer tuvo peor percepción de su CVRS que el varón (p < 0,05). La edad influyó negativamente en todas las dimensiones del SF-36, sobre todo en la mujer. El número de síncopes fue el parámetro clínico que más se relacionó con la CVRS. En nuestra serie, los pacientes con síncope vasovagal tienen peor CVRS respecto a la población general de referencia y similar a la que sufre insuficiencia cardíaca. La CVRS es peor en la mujer y empeora con la edad en ambos sexos. Nuestra serie indica que el número de síncopes es el parámetro clínico que mejor se correlaciona con la CVRS. The prevalence and morbidity of the vaso-vagal syncope are wellknown. With the intention of measuring the Quality of Life (QoL) of patients with vaso-vagal syncope, as well as age and gender influence, we have used the Spanish version of Short form 36 (SF-36) questionnaire in those patients and have compared it with the general population and with patients with heart failure. All consecutive patients with vaso-vagal syncope submitted for head-up tilt test performance from January 2001 to December 2002 were included. SF-36 was self-administered prior to the head-up tilt test. Two hundred and seventy one patients were included (50.5% females). In these patients, QoL scores were lower than those of the Spanish general population and similar to those in patients with heart failure. Women's scores were lower in eight dimensions, and only four were lower in men's. Women QoL was worst than men's (p < 0.05). Age had a negative influence on the eight dimensions of SF-36, especially in women. The number of syncopes was the most influential clinic parameter on the QoL of such patients. In our series, patients suffering from vaso-vagal syncope had a poor QoL when compared with heart failure or control populations. Women had lower QoL than men, and there was an age-related worsening in both men and women. Our data show that the number of syncopes is the clinic parameter having the best correlation with QoL.

Ante la ausencia de un protocolo estandarizado y único, presentamos un análisis de 1.661 pacientes consecutivos remitidos para estudio con test de tabla basculante (TTB) desde septiembre de 1990 y analizamos la influencia de la edad y el sexo en sus resultados utilizando 3 protocolos: Westminster, isoproterenol y nitroglicerina (grupos A, B y C). La proporción de mujeres es mayor en el grupo de menor edad. El TTB fue positivo en 592 pacientes. El porcentaje de respuestas positivas (RP) fue más bajo en el grupo A que en los grupos B y C. En los grupos A y C, éste se redujo con la edad a expensas de las RP mixtas, pero no en el grupo B. Los porcentajes de cada tipo de RP son similares en los grupos A y C, y diferentes en el grupo B, sin que el sexo influya en este resultado. Existe una gran similitud entre los protocolos A y C, pero este último obtiene un mayor porcentaje de RP. Because of the absence of a uniform protocol for the head-up tilt table test (HUT), we compared 1,661 consecutive patients with syncope referred for HUT. The influence of age and gender on the results (positive response rate and patterns) obtained with three different protocols, Westminster, isoprenaline and nitroglycerin (groups A, B and C) was analyzed. The proportion of women was larger in the youngest age group. A positive response to HUT was observed in 592 patients. The positive response rate to the HUT was higher in groups B and C than in group A, and the rate diminished with age in groups A and C, because of the decrease in mixed-positive responses, but not in group B. The rate of positive responses was similar in groups A and C, but different in group B; no influence of gender on these results was observed. The results with the Westminster and nitroglycerin protocols were similar, but the rate of positive responses was higher in the latter.

INTRODUCTION AND OBJECTIVES:We report the results of the first Catheter Ablation Registry of the Arrhythmia Working Group of the Andalusian Society of Cardiology (AWGASC) for 2000.METHODS:The register includes information about the ablation procedures performed in 2000, which was collected retrospectively and submitted voluntarily by four out of six cardiac electrophysiology laboratories of the AWGASC. A total of 424 patients (mean age 45 18 years; 50% men) were included. Twelve patients underwent two different ablation procedures, bringing the total number of procedures to 436. The overall success rate (based on current criteria), success rate by procedure, in-hospital mortality, and major complications are reported.RESULTS:The type and distribution of the ablation procedures were atrioventricular nodal re-entry tachycardia ablation, 34%; accessory pathway ablation, 39%; ventricular tachycardia ablation, 8%; atrial tachycardia ablation, 3%; atrioventricular junctional ablation, 9%, and cavo-tricuspid isthmus ablation, 9%. The overall success rate was 94% (range 97.8% to 87.4% in different laboratories), rate of major complications 1.1% (range 0% to 3.7%), and overall mortality 0.23% (1 patient).CONCLUSIONS:These findings summarize the indications and results of catheter ablation procedures performed in 2000 at four cardiac electrophysiology laboratories in Andalusia. This is the first multicenter registry in Spain.

Ventriculoatrial conduction (VAC) is the causative factor of some cases of the so-called ‘pacemaker syndrome’ in patients with VVI pacemakers and can induce the ‘endless-loop arrhythmias’ (ELA), which is the principal drawback against the spreading of VDD or DDD pacemakers. During the last 30 months the presence of V AC was studied in 215 patients during the PM implantation; 104 (48%) were paced with a VVI unit, 100 (47%) with a dual-chamber system and 11 (5%) with a single leads’ VDD device. In the first 56 cases the ventricular pacing was initiated at 80 bpm or 10 bpm higher than the intrinsic rate, maintained during 2 minutes and ended at 130; in the rest of patients the pacing began at 50 bpm and ended at 150 bpm, because of the finding that some patients showed V AC only below 70 bpm. At the end of the study the response of V AC to the intravenous administration of amiodarone (150-300 mg) was tested. The atrial activity was recorded by way of the guide wire of the introducer or the ventricular lead left in the atrium in cases paced with VVI pacers.