Key result
An implantable loop recorder detected syncope-correlated arrhythmia in 19.7% of patients with unexplained syncope, with a history of paroxysmal atrial fibrillation and bundle branch block predicting the need for pacemaker implantation.
Why the study?
The study evaluated the diagnostic utility of an ILR in detecting arrhythmic causes of unexplained syncope and examined clinical factors associated with pacemaker implantation.
Does implantable loop recorder (ILR) implantation improve the diagnosis of symptom-correlated arrhythmia in patients with recurrent unexplained syncope?
Observational (n=173)
Yes
Does implantable loop recorder (ILR) implantation improve the diagnosis of symptom-correlated arrhythmia in patients with recurrent unexplained syncope?
Implantable loop recorders are effective for diagnosing arrhythmias in unexplained syncope, with a history of paroxysmal atrial fibrillation and bundle branch block serving as strong predictors for subsequent pacemaker implantation.
ILR monitoring was associated with arrhythmia detection in unexplained syncope; extends observational evidence on predictors but should not yet change practice.
Background: An implantable loop recorder (ILR) is an effective tool for diagnosing unexplained syncope (US). We examined the diagnostic utility of an ILR in detecting arrhythmic causes of US and determining which clinical factors are associated with pacemaker (PM) implantation. Methods: This retrospective, multicenter, observational study was conducted from February 2006 to April 2018 at 11 hospitals in Korea. Eligible patients with recurrent US received an ILR to diagnose recurrent syncope and document arrhythmia. Results: A total of 173 US patients (mean age, 67.6 16.5 years; 107 men [61.8%]) who received an ILR after a negative conventional workup were enrolled. During a mean follow-up of 9.4 11.1 months, 52 patients (30.1%) had recurrent syncope, and syncopecorrelated arrhythmia was confirmed in 34 patients (19.7%). The ILR analysis showed sinus node dysfunction in 24 patients (70.6%), supraventricular tachyarrhythmia in 4 (11.8%), ventricular arrhythmia in 4 (11.8%), and sudden atrioventricular block in 2 (5.9%). Overall, ILR detected significant arrhythmia in 99 patients (57.2%) irrespective of syncope. Among patients with clinically relevant arrhythmia detected by ILR, PM implantation was performed in 60 (34.7%), an intra-cardiac defibrillator in 5 (2.9%), and catheter ablation in 4 (2.3%). In
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Lee et al. (2019) conducted an observational in Unexplained syncope (n=173). Implantable loop recorder (ILR) was evaluated on Symptom-correlated ECG diagnosis by ILR interrogation during the first recurrent syncope. An implantable loop recorder detected syncope-correlated arrhythmia in 19.7% of patients with unexplained syncope, with a history of paroxysmal atrial fibrillation and bundle branch block predicting the need for pacemaker implantation.
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