What is the clinical evidence from this study?

Study design: Case Report. Population: Unexplained syncope and paroxysmal atrial fibrillation (n=1). Intervention: Implantable loop recorder (ILR). Primary outcome: Detection of arrhythmia causing syncope.

What question did this study set out to answer?

The aim is to identify the cause of recurrent syncope in an elderly patient using advanced cardiac monitoring.

April 1, 2026Open Access

Bradycardia-tachycardia syndrome detected by an implantable loop recorder in a patient with syncope and paroxysmal atrial fibrillation

Key Result

An implantable loop recorder successfully detected bradycardia-tachycardia syndrome in a patient with unexplained syncope after conventional tests failed.

Key Points

The aim is to identify the cause of recurrent syncope in an elderly patient using advanced cardiac monitoring.
Patient underwent thorough cardiac evaluations including ECG, EPS, and tilt test.
An implantable loop recorder was implanted after conventional tests yielded normal results.
Event monitoring captured episodes of paroxysmal atrial fibrillation and sinus arrest.
Bradycardia-tachycardia syndrome was confirmed after capturing critical rhythms.
Quality of life improved significantly following pacemaker implantation.
The patient did not experience any further syncopal episodes post-surgery.

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Population

83-year-old woman with frequent unexplained syncopal and presyncopal episodes and paroxysmal atrial fibrillation

Intervention

Implantable loop recorder (ILR) implantation

Outcome

Diagnosis of the cause of syncope

Implantable loop recorders can successfully diagnose elusive causes of syncope, such as bradycardia-tachycardia syndrome, when conventional evaluations like Holter monitoring and electrophysiological studies fail.

Abstract

We describe a case of frequent unexplained syncopal episodes in a patient with negative results on conventional evaluations that was ultimately diagnosed with the use of an implantable loop recorder (ILR). An 83-year-old woman with a history of several presyncopal episodes was admitted to our hospital for a comprehensive evaluation. Findings from 12-lead electrocardiography (ECG), an electrophysiological study (EPS), and a tilt test were normal. Because she remained undiagnosed for 10 months, we implanted an ILR. Four months after implantation, paroxysmal atrial fibrillation (PAF) and atrial fibrillation (AF) flutter followed by sinus arrest were captured, and these events corresponded to syncopal episodes. A diagnosis of bradycardia-tachycardia syndrome (BTS) was ultimately confirmed. The patient's quality of life (QOL) has substantially improved after pacemaker implantation, with no recurrence of syncope. 症例は,前失神発作を何度も認め,前医で診断に至らなかった83 歳の女性.Holter 心電図,12 誘導心電図,Tilt 試験,電気生理学検査(electrophysiological study:EPS)等の従来の検査を再度当院で行ったが,すべて正常であった.初発発作を認めてから10 カ月間診断に至らず,失神を認めるため植え込み型ループレコーダ(implantable loop recorder:ILR)を植え込む方針とした.植え込み4 カ月後に失神し,ILRで心房粗細動とその停止後に5.8 秒の洞停止を認め,初めて「徐脈頻脈症候群」と診断した.診断後すぐにペースメーカ植え込み術を行い,術後は1 度も失神せずに経過している.今回,従来の検査では診断できず,ILR 植え込みにより診断に繋がった徐脈頻脈症候群の1 例を経験したので,症例報告する.

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