Key result
Implantable loop recorders successfully documented supraventricular tachycardia as the cause of recurrent syncope in four patients with mixed diagnostic findings, guiding curative ablation.
Why the study?
Diagnostic workup for syncope often reveals mixed mechanisms, creating clinical uncertainty that implantable loop recorders may help resolve by correlating symptoms with arrhythmias.
Does an implantable loop recorder help establish the diagnosis of SVT-induced syncope in patients with recurrent unexplained syncope and mixed mechanisms on baseline testing?
Case Report (n=4)
No
Does an implantable loop recorder help establish the diagnosis of SVT-induced syncope in patients with recurrent unexplained syncope and mixed mechanisms on baseline testing?
In patients with recurrent unexplained syncope and mixed findings on initial electrophysiologic and tilt-table testing, implantable loop recorders can definitively identify paroxysmal SVT as the cause, enabling curative catheter ablation.
May support ILR evaluation in select refractory syncope; hypothesis-generating and leaves open need for prospective validation.
Syncope represents a relatively uncommon symptom of supraventricular tachycardia (SVT). It is likely that an impaired autonomic vasomotor response to the hemodynamic stress of tachycardia is the determinant of hemodynamic changes leading to cerebral hypoperfusion and syncope. In this regard, tilt-table test may detect abnormalities in the autonomic nervous function and predict the occurrence of syncope during SVT. Electrophysiology studies may reproduce the SVT, distinguish it from other life-threatening ventricular tachyarrhythmias, and exclude other causes of syncope. Not infrequently mixed syncope mechanisms are revealed during the above diagnostic workup raising doubts about the operating mechanism in the clinical setting. In such cases of uncertainty, an implantable loop recorder, providing long-term cardiac monitoring, may play a pivotal role in the establishment of the diagnosis, confirming the association of an arrhythmic event with the symptom. Herein, we present four such cases with recurrent unexplained syncope finally attributed to paroxysmal SVT guiding them to a potentially radical treatment through radiofrequency catheter ablation.
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Σουλαϊδόπουλος et al. (2021) conducted a case report in Recurrent unexplained syncope (n=4). Implantable loop recorder was evaluated on Documentation of a cause-and-effect relationship between arrhythmia and syncope. Implantable loop recorders successfully documented supraventricular tachycardia as the cause of recurrent syncope in four patients with mixed diagnostic findings, guiding curative ablation.
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