The role and value of electrophysiological study (EPS) for syncope in heart transplant patient has never been analyzed and described in current guidelines.

To analyse if EPS was relevant in diagnostic strategy of syncope in heart transplant patient who required permanent pacemaker implantation (PPI).

Between 1982 and 2012, 45 patients underwent PPI and among them EPS was performed in 9. Data were retrospectively collected including indication of pacemaker implantation, method of transplantation (biatrial versus bicaval), ECG just before PPI and results of EPS.

Mean recipient age was 53±19 year old and mean donor age was 50±12 year old. Six patients (67%) underwent biatrial surgery and three underwent bicaval one. Mean permanent pacemaker implantation delay after transplantation was 139±78 months. Six patients had PPI for paroxysmal atrioventricular block and three for sinus node disease. PPI was required according to the results of EPS only in three patients: infra-hisian delay and block in two of them with preexisting large QRS, and sinus node dysfunction in one.

Electrophysiological study for syncope in heart transplant patient has a low specificity. As in general population after an inconclusive EPS, external or implantable loop recorder could be useful during follow-up to early detect bradyarrhythmias necessitating permanent pacemaker implantation.