Abstract 10988: The Remote Monitoring of Unexplained Syncope in the Elderly
Introduction: Syncope is a major health burden, particularly in the elderly and is associated with increased mortality and morbidity in this patient group. This is often due to the presence of cognitive impairment or physiological deterioration. This, in conjunction with the unpredictable nature of symptoms can result in unexplained syncope becoming a diagnostic challenge. We examined the use of a remotely monitored 2nd generation implantable loop recorder (ILR) with Wi-Fi and Bluetooth technology to assist in the diagnosis of unexplained syncope in an elderly population,as compared with conventional management.
Methods and Results: Of 246 patients in a randomised prospective study, 191 patients (79.2%, 120 female) aged ≥ 60 were analysed. The ILR used was the Sleuth (Transoma Medical Inc., MN). There were no implant complications. Minimum follow up time was 12 months. Patients were randomised to 4 groups (ILR alone, ILR + syncope clinic, conventional management + syncope clinic and conventional management alone). Diagnostic yields were 40.7% in the ILR group (22 patients) with a mean time to diagnosis of 117.4 days, and 55.3% (26 patients) in the ILR and syncope clinic group (mean time to diagnosis 77.1 days). Only 1 conventionally managed patient (2%) achieved ECG diagnosis. ILR patients achieved ECG diagnosis earlier (HR= 3.338, 95% CI: 1.839-6.060, p=0.000. Patients attending syncope clinic also achieved ECG diagnosis earlier (HR 2.283, 95% CI: 1.362- 3.825, p=0.002) although this was in conjunction with diagnoses obtained from positive tilt tests. Device data correlated well with peri-event tilt test information in device patients.
Conclusion: Remote monitoring of unexplained syncope in elderly patients is associated with an increased diagnostic yield and improved symptom-rhythm correlation. It is therefore effective as an investigative modality in this cohort.
- © 2011 by American Heart Association, Inc.