Ix of syncope prior to TKR

80yo man for L TKR. 


  • Episode of LOC several years ago
  • Isolated event. Nil seizure-like features.
  • Witnessed by family members
  • Extensive review by neurologist – EEG showed prominent epileptiform features in the temporal lobe which were reproducible on repeat testing. 
  • EEG abnormalities resolved with commencement of Levetiracetam. 
  • Bifascicular block on ECG, HR 59, no cardiologist review


Should we be concerned about a cardiac cause for his LOC?

  • Reassuring features:
    • One distant episode. 
    • Now treated for epilepsy. No further episodes.
    • EEG showed a gross abnormality and repeat EEG after treatment was normal.
  • Concerning features:
    • Episode doesn’t really sound like a seizure. Sounds more cardiac in origin.
  • Unlikely that a cardiologist be interested in one episode of LOC
  • Holter = low risk study however likely wasted resource and burdensome to patient 


  • Proceed with surgery without further investigations.