An implantable loop recorder successfully diagnosed AV junctional rhythm as the cause of recurrent syncope in a young man with first-degree AV block, leading to effective pacemaker therapy.
May support ILR-guided pacing in select syncope with AV block; leaves open need for prospective validation before practice change.
A 20-year old man experienced recurrent syncope, that suggested a partially neutrally-mediated mechanism, but in some cases were without a prodrome. The tilt test was negative. The 12-lead ECG and electrophysiological study showed first-degree AV block. Syncope in bradyarrhythmia was suspected and an implantable loop recorder was indicated. In the first month after implantation the patient experienced one syncopal episode. In the stored ECG, AV junctional rhythm was detected. The patient received a pacemaker and symptoms improved.
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Lelonek et al. (2008) studied this question.
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