© 2005 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved.
Utility of implantable loop recorder (Reveal Plus®) in the diagnosis of unexplained syncope
aCardiologia, Dipartimento di Medicina, Chirurgia e Odontoiatria, Osp. San Paolo, Universitŕ di Milano Via A. di Rudině 8, 20142 Milano, Italy; bCardiologia Spedali Civili di Brescia Milano, Italy; cCardiologia Ospedale di Lodi Milano, Italy; dMedtronic Milano Milano, Italy; eCardiologia Ospedale di Saronno Milano, Italy; fCardiologia Ospedale San Carlo Milano, Italy; gCardiologia Ospedale di Melegnano Milano, Italy; hCardiologia Ospedale Niguarda Milano, Italy
AIMS: In about 30% of patients with syncope, the responsible mechanisms remain unrecognised. Nevertheless, the possibility of an arrhythmic aetiology remains, however, difficult to rule out.
METHODS: We therefore monitored with an implantable loop recorder (ILR, Reveal Plus®, Medtronic) 34 subjects (60 ± 15 years) with at least two unexplained syncopal episodes and negative neurological and cardiovascular work-up.
RESULTS: During a follow-up of 7 ± 4 months, syncope occurred in 11 subjects. In nine of them the mechanisms responsible for these events were identified by ILR monitoring: marked bradycardia or asystole (n = 6), atrial fibrillation with wide QRS tachycardia (n = 1) and sinus rhythm with fine artifacts likely to be due to muscle contractions (n = 2). Pre-syncope occurred in seven patients: advanced atrioventricular block (n = 3), sinus tachycardia (n = 1), and wide QRS tachycardia (n = 1) were documented. Thus, when considering all 18 patients with recurrences, a diagnosis was achieved in 53% of subjects. Recognition of the rhythm disorder in seven patients with syncope and four patients with pre-syncope guided patient management.
CONCLUSIONS: These data indicate that ILR monitoring facilitates the identification of mechanisms responsible for recurrences and therapeutic management in subjects with syncope or pre-syncope and negative traditional neurological and cardiovascular work-up.
Key Words: bradycardia, electrocardiographic monitoring, tilt test, epilepsy
*Corresponding author. Tel./fax: +39 02 50323145. E-mail address: federico.lombardi{at}unimi.it (F. Lombardi).
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