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Diagnostic benefit of the use of implanted loop recorder (Reveal Plus) for patients with syncope with unclear aetiology


Authors: P. Mitro;  M. Szakács;  J. Bodnár;  G. Valočik;  P. Kirsch;  K. Mudráková
Authors‘ workplace: III. interná klinika Lekárskej fakulty UPJŠ a FN L. Pasteura Košice, Slovenská republika, prednosta doc. MUDr. Peter Mitro, PhD.
Published in: Vnitř Lék 2007; 53(11): 1147-1152
Category: Original Contributions

Overview

The objective of the study was to evaluate the diagnostic yield of a loop recorder (Reveal Plus, Medtronic) in the diagnosis of syncope conditions whose aetiology remains unclear despite the performance of a full diagnostic procedure.

Patients and method:
Loop recorders were implanted in 25 patients with recurrent syncope (9 men, 16 women, average age 59 ± 14 years), who reported 4 ± 2.7 episodes of syncope (2–10 episodes). A complete diagnostic algorithm was performed for all patients before implantation including the head-up tilt test, an invasive electrophysiological examination and a neurological examination. The aetiology of the syncope was not established by these examinations.

Results:
During an average monitoring period of 13 ± 8 months (1–24 months) 10 patients experiences recidivating syncope, 7 patients experienced pre-syncope and 1 patient experienced palpitations. 7 were asymptomatic during monitoring. Symptomatic arrhythmia was detected in 10 patients (40%). The most frequent finding was bradyarrhythmia (6 patients – sinus arrest in 3 patients, serious bradycardia in 2 patients, AV block in 1 patient). Tachyarrhythmia was the cause of symptoms in 4 patients (supraventricular tachycardia in 3 patients, ventricular bigeminy in 1 patient). In the case of 5 patients (20%) syncope (pre-syncope) took place in the absence of a serious arrhythmia and was classified as vasovagal syncope.

Conclusion:
The implantable loop recorder established a diagnosis in 15 of 25 patients (60%) with syncope that was not diagnosed by conventional tests and it is a highly beneficial method for diagnosing syncope.

Key words:
syncope – diagnosis – implantable loop recorder


Sources

1. Ashby DT, Cehic DA, Disney PJ et al. A retrospective case study to assess the value of the implantable loop recorder for the investigation of undiagnosed syncope. Pacing Clin Electrophysiol 2002; 25: 1200-1205.

2. Assar MD, Krahn AD, Klein GJ et al. Optimal duration of monitoring in patients with unexplained syncope. Am J Cardiol 2003; 92: 1231-1233.

3. Boersma L, Mont L, Sionis A et al. Value of the implantable loop recorder for the management of patients with unexplained syncope. Europace 2004; 6: 70-76.

4. Brignole M International study on syncope of uncertain aetiology 3 (ISSUE 3): pacemaker therapy for patients with asystolic neurally-mediated syncope: rationale and study design. Europace 2007; 9: 25-30.

5. Brignole M, Moya A, Menozzi C et al. Proposed electrocardiographic classification of spontaneous syncope documented by an implantable loop recorder. Europace 2005; 7: 14-18.

6. Brignole M, Sutton R, Menozzi C et al. Early application of an implantable loop recorder allows effective specific therapy in patients with recurrent suspected neurally mediated syncope. Eur Heart J 2006; 27: 1085-1092.

7. Brignole M, Menozzi C, Moya A et al. Mechanism of syncope in patients with bundle branch block and negative electrophysiological test. Circulation 2001; 104: 2045-2050.

8. Brignole M, Menozzi C, Maggi R et al. The usage and diagnostic yield of the implantable loop-recorder in detection of the mechanism of syncope and in guiding effective antiarrhythmic therapy in older people. Europace 2005; 7: 273-279.

9. Brignole M, Alboni P, Benditt DG et al. Guidelines on management (diagnosis and treatment) of syncope - update 2004. Europace 2004; 6: 467-537.

10. Colivicchi F, Ammirati F, Melina D et al. Development and prospective validation of a risk stratification system for patients with syncope in the emergency department: the OESIL risk score. Eur Heart J 2003; 24: 811-819.

11. Deharo JC, Jego C, Lanteaume A et al. An implantable loop recorder study of highly symptomatic vasovagal patients: the heart rhythm observed during a spontaneous syncope is identical to the recurrent syncope but not correlated with the head-up tilt test or adenosine triphosphate test. J Am Coll Cardiol 2006; 47: 587-593.

12. Enseleit F, Duru F. Long-term continuous external electrocardiographic recording: a review. Europace 2006; 8: 255-266.

13. Farwell DJ, Freemantle N, Sulke N. The clinical impact of implantable loop recorders in patients with syncope. Eur Heart J 2006; 27: 351-356.

14. Ho RT, Wicks T, Wyeth D et al. Generalized tonic-clonic seizures detected by implantable loop recorder devices: diagnosing more than cardiac arrhythmias. Heart Rhythm 2006; 3: 857-861.

15. Kovac J, Skehan JD. Long-term monitoring of patients with a syncope of obscure etiology with an implantable monitoring device. Vnitř Lék 2000; 46: 328-331.

16. Krahn AD, Klein GJ, Yee R et al. Use of an extended monitoring strategy in patients with problematic syncope. Reveal Investigators. Circulation 1999; 99: 406-410.

17. Krahn AD, Klein GJ, Fitzpatrick A et al. Predicting the outcome of patients with unexplained syncope undergoing prolonged monitoring. Pacing Clin Electrophysiol 2002; 25: 37-41.

18. Menozzi C, Brignole M, Garcia-Civera R et al. Mechanism of syncope in patients with heart disease and negative electrophysiologic test. Circulation 2002; 105: 2741-2745.

19. Mitro P. Therapy of vasovagal syncoope (cardiostimulation therapy). Vnitř Lék 2000; 46: 869-873.

20. Moya A, Brignole M, Menozzi C et al. Mechanism of syncope in patients with isolated syncope and in patients with tilt-positive syncope. Circulation 2001; 104: 1261-1267.

21. Nierop PR, van Mechelen R, van Elsacker A et al. Heart rhythm during syncope and presyncope: results of implantable loop recorders. Pacing Clin Electrophysiol 2000; 23: 1532-1538.

22. Rockx MA, Hoch JS, Klein GJ et al. Is ambulatory monitoring for “community-acquired” syncope economically attractive? A cost-effectiveness analysis of a randomized trial of external loop recorders versus Holter monitoring. Am Heart J 2005; 150: 1065.

23. Sarasin FP, Carballo D, Slama S et al. Usefulness of 24-h Holter monitoring in patients with unexplained syncope and a high likelihood of arrhythmias. Int J Cardiol 2005; 101: 203-207.

24. Sivakumaran S, Krahn AD, Klein GJ et al. A prospective randomized comparison of loop recorders versus Holter monitors in patients with syncope or presyncope. Am J Med 2003; 115: 1-5.

25. Solano A, Menozzi C, Maggi R et al. Incidence, diagnostic yield and safety of the implantable loop-recorder to detect the mechanism of syncope in patients with and without structural heart disease. Eur Heart J 2004; 25: 1116-1119.

26. Soteriades ES, Evans JC, Larson MG et al. Incidence and prognosis of syncope. N Engl J Med 2002; 347: 878-885.

27. Sovova E, Doupal V, Lukl J. Comparison of two types of devices for long-term Holter monitoring of the ECG in detection of heart arrhythmias. Vnitř Lék 2001; 47: 670-673.

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2007 Issue 11

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