© 2005 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved.
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
aArrhythmologic Centre, Department of Cardiology, Ospedali del Tigullio via don Bobbio 25, 16033 Lavagna, Italy; bInterventional Cardiology Unit, Department of Cardiology, Azienda Ospedaliera Santa Maria Nuova via Risorgimento 80, 42100 Reggio nell'Emilia, Italy
OBJECTIVES: To evaluate the usage and diagnostic yield of the implantable loop-recorder (ILR) in detection of the mechanism of syncope and in guiding therapy in patients aged 
65 years and comparing them with those <65 years.
DESIGN: This was a two-hospital, observational, prospective study in consecutive patients with unexplained syncope who underwent an ILR implantation. Between November 1997 and December 2002, a total of 2052 patients with syncope were evaluated (local population of 590,000 inhabitants). The diagnosis remained unexplained in 371 (18%). Of these, 103 patients (5% of the total, 28% of those with unexplained syncope) received an ILR.
RESULTS: There were 70 (76%) patients aged 65 years and 25 (24%) <65 years. ILR implantation was 110 and 9 per million inhabitants per year, respectively. During a mean follow-up of 14 ± 10 months, syncope was recorded in 52 patients. Compared with younger patients those older had a 2.7 higher syncope recurrence rate (56% vs 32%, P = 0.03); arrhythmias were 3.1 times more likely to be responsible for syncope (44% vs 20%, P = 0.03). More patients 65 years finally received ILR-guided therapy (42% vs 20%, P = 0.04). Among the 29 patients (25 of those 65 years) who received specific antiarrhythmic therapy, only one (3%), had recurrence of syncope during the subsequent follow-up of 40 ± 18 months.
CONCLUSIONS: In patients referred for investigation of unexplained syncope, the older subjects are more likely to have an indication for ILR implantation than those younger, ILR has a higher diagnostic value, an arrhythmia is more likely to be detected and successfully treated.
Key Words: syncope, implantable loop-recorder, ageing, arrhythmia, pacemaker
*Corresponding author. Arrhythmologic Centre, Department of Cardiology, Ospedali del Tigullio, Via don Bobbio 24, 16033 Lavagna, Italy. Tel.: +39 0185 329567; fax: +39 0185 306506. E-mail address: mbrignole{at}asl4.liguria.it (M. Brignole).
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  A. J. Turley, M. M. Tynan, and C. J. Plummer Time to manual activation of implantable loop recorders--implications for programming recording period: a 10-year single-centre experience Europace, October 1, 2009; 11(10): 1359 - 1361. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Task Force members, M. Brignole, P. Vardas, E. Hoffman, H. Huikuri, A. Moya, R. Ricci, N. Sulke, W. Wieling, EHRA Scientific Documents Committee, et al. Indications for the use of diagnostic implantable and external ECG loop recorders Europace, May 1, 2009; 11(5): 671 - 687. [Full Text] [PDF]
|
|
|
|
|
|
The Steering Committee of the ISSUE 3 Study International study on syncope of uncertain aetiology 3 (ISSUE 3): pacemaker therapy for patients with asystolic neurally-mediated syncope: rationale and study design Europace, January 1, 2007; 9(1): 25 - 30. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Petkar, P. Cooper, and A. P Fitzpatrick How to avoid a misdiagnosis in patients presenting with transient loss of consciousness. Postgrad. Med. J., October 1, 2006; 82(972): 630 - 641. [Abstract] [Full Text] [PDF]
|
|