Korean Circ J.  2008 Apr;38(4):205-211. 10.4070/kcj.2008.38.4.205.

The Use of an Implantable Loop Recorder in Patients With Syncope of Unknown Origin

Affiliations
  • 1Division of Cardiology, Cardiac and Vascular Center, Samsung Medical Center Sungkyunkwan University School of Medicine, Seoul, Korea. juneskim@skku.edu
  • 2Division of Cardiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
  • 3Division of Cardiology, Department of Medicine, Sam Anyang General Hospital, Anyang, Korea.

Abstract

BACKGROUND AND OBJECTIVES: Possible mechanisms of syncope often remain unknown despite the performance of extensive cardiological and neurological tests. An implantable loop recorder (ILR) has been introduced to monitor the heart rhythm continuously over a year. We evaluated the diagnostic value of the use of the ILR for unexplained syncope.
SUBJECTS AND METHODS
Between 2006 and 2007, an ILR was implanted in 9 patients (7 male, 2 female, mean age 55+/-17 years) where syncope remained unexplained after extensive diagnostic tests. We analyzed the recorded electrocardiogram signal in the memory of the ILR.
RESULTS
During a follow-up period of 8.8+/-7.3 months, arrhythmia was detected in five patients. Two patients had a sinus pause and received a permanent pacemaker, and one patient had sustained ventricular tachycardia and fibrillation and received an implantable cardioverter defibrillator. One patient had micturition syncope with sinus pause and is waiting for permanent pacemaker implantation, and one patient had symptomatic paroxysmal atrial fibrillation and was administered anticoagulation therapy. Inappropriate auto-activations such as a pseudopause or a decreasing signal were also noted.
CONCLUSION
ILR monitoring seems to be a useful diagnostic tool to identify the arrhythmic cause in patients with unexplained syncope.

Keyword

Syncope; Electrocardiography monitoring, ambulatory; Arrhythmia

MeSH Terms

Arrhythmias, Cardiac
Atrial Fibrillation
Defibrillators
Diagnostic Tests, Routine
Electrocardiography
Electrocardiography, Ambulatory
Female
Follow-Up Studies
Heart
Humans
Male
Memory
Organothiophosphorus Compounds
Syncope
Tachycardia, Ventricular
Organothiophosphorus Compounds

Figure

  • Fig. 1 Implantable loop recorder (A) with manual activator (B).

  • Fig. 2 Pre-implant mapping. Before implantation, optimal ECG signal was tested through 4 ways. 1: vertical, 2: right vertical, 3: left vertical, 4: horizontal. ECG: electrocardiography.

  • Fig. 3 Typical sinus pause (A) and pseudopause (B). Arrow: loss of signal with amplifier saturation and reacquisition of signal is seen, which is detected automatically as a pause (inappropriate auto-activation). ▴A: automatic activation point.

  • Fig. 4 Ventricular tachycardia and fibrillation. The patient lost his consciousness trasiently due to a symptomatic ventricular tachycardia and fibrillation lasting 90 seconds. ▴P: patient activation point.

  • Fig. 5 Inappropriate auto-activation. Due to undersensing of decreasing signal (A), and oversensing of signal noise artifact (B). ▴A: automatic activation point. ▴P: patient activation point.


Cited by  1 articles

Usefulness of an Implantable Loop Recorder in Patients with Syncope of an Unknown Cause
Gu Hyun Kang, Ju Hyeon Oh, Woo Jung Chun, Yong Hwan Park, Bong Gun Song, June Soo Kim, Young Keun On, Seung Jung Park, June Huh
Yonsei Med J. 2013;54(3):590-595.    doi: 10.3349/ymj.2013.54.3.590.


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