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(Circulation. 1999;99:406-410.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Use of an Extended Monitoring Strategy in Patients With Problematic Syncope
From the Division of Cardiology, University of Western Ontario, London, Ontario, Canada, and Medtronic, Minneapolis, Minn (T.T.-N.).
Background—The conventional investigation of patients who present with syncope involves short-term ECG monitoring or provocative testing with head-up tilt and electrophysiological testing. A symptom-rhythm correlation is often difficult to obtain during spontaneous syncope because of its sporadic, infrequent, and unpredictable nature.
Methods and Results—We used a prolonged monitoring strategy to determine the cause of syncope in 85 patients (age, 59±18 years; 44 men) with recurrent undiagnosed syncope with an implantable loop recorder capable of cardiac monitoring for up to 18 months. During a mean of 10.5±4.0 months of follow-up, symptoms recurred in 58 patients (68%) 71±79 days (2.3±2.6 months) after implantable loop recorder insertion. An arrhythmia was detected in 42% of patients who recorded a rhythm during recurrent symptoms, with bradycardia present in 18 and tachycardia in 3. Five of the 18 bradycardic patients and 2 additional sinus rhythm patients received a clinical diagnosis of neurally mediated syncope. Patients who experienced presyncope were much less likely to record an arrhythmia during symptoms compared with recurrence of syncope (24% versus 70%, P=0.0005). There were no adverse events associated with recurrent symptoms, and there were no sudden deaths. Inability to freeze after an event occurred in 8 patients, and pocket infection occurred in 3.
Conclusions—The strategy of prolonged monitoring is effective and safe in patients with problematic syncope.
Key Words: syncope • arrhythmia • diagnosis
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|
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|
 |
|
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|
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|
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|
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|
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|
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|
|
|
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|
|
|
|
|
|
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|
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|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
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|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
J R Gimbel Novel use of an "insertable" loop recorder Heart, June 1, 2003; 89(6): e18 - 18. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. N. Kapoor Is There an Effective Treatment for Neurally Mediated Syncope? JAMA, May 7, 2003; 289(17): 2272 - 2275. [Full Text] [PDF]
|
|
|
|
|
|
S. I. Chrysostomakis, N. C. Klapsinos, E. N. Simantirakis, M. E. Marketou, D. C. Kambouraki, and P. E. Vardas Sensing issues related to the clinical use of implantable loop recorders Europace, January 1, 2003; 5(2): 143 - 148. [Abstract] [PDF]
|
|
|
|
 |
|
 W. H. Maisel and W. G. Stevenson Syncope -- Getting to the Heart of the Matter N. Engl. J. Med., September 19, 2002; 347(12): 931 - 933. [Full Text] [PDF]
|
|
|
|
 |
|
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|
|
|
|
|
|
S. I. Chrysostomakis, E. N. Simantirakis, M. E. Marketou, and P. E. Vardas Implantable loop recorder undersensing mimicking complete heart block Europace, January 1, 2002; 4(2): 211 - 213. [Abstract] [PDF]
|
|
|
|
|
|
A. Moya, M. Brignole, C. Menozzi, R. Garcia-Civera, S. Tognarini, L. Mont, G. Botto, F. Giada, and D. Cornacchia Mechanism of Syncope in Patients With Isolated Syncope and in Patients With Tilt-Positive Syncope Circulation, September 11, 2001; 104(11): 1261 - 1267. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. A. Pires, J. R. Ganji, R. Jarandila, and R. Steele Diagnostic Patterns and Temporal Trends in the Evaluation of Adult Patients Hospitalized With Syncope Arch Intern Med, August 13, 2001; 161(15): 1889 - 1895. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
|
|
A. D. Krahn, G. J. Klein, R. Yee, and A. C. Skanes Randomized Assessment of Syncope Trial : Conventional Diagnostic Testing Versus a Prolonged Monitoring Strategy Circulation, July 3, 2001; 104(1): 46 - 51. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. BRIGNOLE, C. MENOZZI, A. MOYA, and R. GARCIA-CIVERA Implantable loop recorder: towards a gold standard for the diagnosis of syncope? Heart, June 1, 2001; 85(6): 610 - 612. [Full Text]
|
|
|
|
 |
|
 W Arthur and G C Kaye Current investigations used to assess syncope Postgrad. Med. J., January 1, 2001; 77(903): 20 - 23. [Full Text]
|
|
|
|
|
|
W. N. Kapoor Syncope N. Engl. J. Med., December 21, 2000; 343(25): 1856 - 1862. [Full Text] [PDF]
|
|
|
|
|
|
J. M. Mangrum and J. P. DiMarco The Evaluation and Management of Bradycardia N. Engl. J. Med., March 9, 2000; 342(10): 703 - 709. [Full Text] [PDF]
|
|
|
|
|
|
K. Seidl, M. Rameken, S. Breunung, J. Senges, W. Jung, D. Andresen, A. Van Toor, A. D. Krahn, G. J. Klein, and on behalf of the Reveal-Investigators Diagnostic assessment of recurrent unexplained syncope with a new subcutaneously implantable loop recorder Europace, January 1, 2000; 2(3): 256 - 262. [Abstract] [PDF]
|
|
|
|
|
|
T. M. Hoorntje, W. Langerak, and N. Sreeram Munchausen's Syndrome by Proxy Identified with an Implantable Electrocardiographic Recorder N. Engl. J. Med., November 4, 1999; 341(19): 1478 - 1479. [Full Text]
|
|
|
|
 |
|
 A. D. Krahn, G. J. Klein, R. Yee, and A. C. Skanes Recording that elusive rhythm Can. Med. Assoc. J., November 1, 1999; 161(11): 1424 - 1425. [Full Text] [PDF]
|
|
|
|
|
|
M. H. Crawford, S. J. Bernstein, P. C. Deedwania, J. P. DiMarco, K. J. Ferrick, A. Garson Jr, L. A. Green, H. L. Greene, M. J. Silka, P. H. Stone, et al. ACC/AHA guidelines for ambulatory electrocardiography: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the Guidelines for Ambulatory Electrocardiography) developed in collaboration with the North American Society for Pacing and Electrophysiology J. Am. Coll. Cardiol., September 1, 1999; 34(3): 912 - 948. [Full Text] [PDF]
|
|
|
|
 |
|
 P. J. Zimetbaum and M. E. Josephson The Evolving Role of Ambulatory Arrhythmia Monitoring in General Clinical Practice Ann Intern Med, May 18, 1999; 130(10): 848 - 856. [Abstract] [Full Text] [PDF]
|
|