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The utility of implantable loop recorders for diagnosing unexplained syncope in 100 consecutive patients: five-year, single-center experience Inamdar V; Mehta S; Juang G; Cohen TJ Invasive Cardiol 2006[Jul]; 18 (7): 313-5INTRODUCTION: The purpose of this study was to retrospectively review the 5-year experience of a university hospital with implantable loop recorders (ILR) for the diagnosis of recurrent, unexplained syncope or presyncope. METHODS: One hundred patients with syncope or presyncope of unknown etiology (negative tilt-table test, electrophysiology study and neurologic workup) underwent prolonged monitoring with an ILR from March 2000 to December 2004. All implants were performed using a first-generation (manual activation) or second-generation (manual plus automatic activation) ILR. RESULTS: One hundred patients (70 women, 30 men) with a mean age of 68 +/- 18 years received the ILR. Twenty-three patients had coronary artery disease; 2 patients had dilated cardiomyopathy. Ten patients received a first-generation ILR, and 90 patients received a second-generation ILR. After 9 +/- 8 months' follow up, ILR interrogation identified an arrhythmogenic etiology to the syncope/presyncope in 45 patients with 55 events. Eight patients had a diagnosis by ILR less than 2 months from the date of implantation. Twenty-six patients had documented symptomatic bradycardia (asystole, sinus pauses, atrial fibrillation with long pauses); 11 patients had episodes of sinus tachycardia with heart rates of 130 to 140 beats/minute; 2 patients had atrial tachycardia; 5 patients had multiple episodes of nonsustained ventricular tachycardia (NSVT); 1 patient had sustained ventricular tachycardia, and 4 patients had paroxysmal supraventricular tachycardia. All arrhythmias were treated successfully by pacemaker/ICD implantation, radiofrequency catheter ablation and/or medications. One patient had seizure activity, which was detected by ILR as high-frequency noise. Two patients failed to activate their device, as it was a first-generation device. CONCLUSION: Five-year experience with the ILR in 100 consecutive patients confirms the utility of this device in the diagnosis of recurrent, infrequent, unexplained syncope or presyncope. It helped diagnose 45% of patients with unexplained syncope with negative electrophysiologic and neurologic workup. Most of these patients had an arrhythmogenic etiology to their syncope. Medical therapy, device therapy, and/or catheter ablation helped successfully treat all patients with an arrhythmogenic etiology detected by ILR.|Adrenergic beta-Antagonists/therapeutic use[MESH]|Aged[MESH]|Aged, 80 and over[MESH]|Amiodarone/therapeutic use[MESH]|Anti-Arrhythmia Agents/therapeutic use[MESH]|Arrhythmias, Cardiac/*complications/*diagnosis/physiopathology/therapy[MESH]|Defibrillators, Implantable[MESH]|Electrocardiography, Ambulatory/*instrumentation/*methods[MESH]|Electrodes, Implanted[MESH]|Electrophysiology[MESH]|Equipment and Supplies/standards[MESH]|Female[MESH]|Humans[MESH]|Longitudinal Studies[MESH]|Male[MESH]|Middle Aged[MESH]|Retrospective Studies[MESH]|Syncope/*diagnosis/*etiology/physiopathology[MESH]|Treatment Outcome[MESH] |
