open access

Vol 26, No 1 (2019)
Original articles — Clinical cardiology
Published online: 2018-01-25
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Implantable loop recorders in patients with unexplained syncope: Clinical predictors of pacemaker implantation

Martin Huemer, Ann-Kristin Becker, Alexander Wutzler, Philipp Attanasio, Abdul S. Parwani, Philipp Lacour, Leif-Hendrik Boldt, Burkert Pieske, Wilhelm Haverkamp, Florian Blaschke
DOI: 10.5603/CJ.a2018.0008
·
Pubmed: 29399750
·
Cardiol J 2019;26(1):36-46.

open access

Vol 26, No 1 (2019)
Original articles — Clinical cardiology
Published online: 2018-01-25

Abstract

Background: Implantable loop recorders (ILR) are a valuable tool for the investigation of unexplained syncopal episodes. The aim of this retrospective single center study was to identify predictive factors for pacemaker implantation in patients with unexplained syncope who underwent ILR insertion.

Methods: One hundred six patients were retrospectively analyzed (mean age 59.1 years; 47.2% male) with unexplained syncope and negative conventional testing who underwent ILR implantation. The pri- mary study endpoint was detection of symptomatic or asymptomatic bradycardia requiring pacemaker implantation. 

Results: The average follow-up period after ILR implantation was 20 ± 15 months. Pacemaker im- plantation according to current guidelines was necessary in 22 (20.8%) patients, mean duration until index bradycardia was 81 ± 88 (2–350) days. Ten (45.5%) patients received a pacemaker due to sinus arrest, 7 (31.8%) patients due to third-degree atrioventricular block, 2 (9.1%) patients due to second- degree atrioventricular block and 1 (4.5%) patient due to atrial fibrillation with a slow ventricular rate. Three factors remained significant in multivariate analysis: obesity, which defined by a body mass index above 30 kg/m2 (OR: 7.39, p = 0.014), a right bundle branch block (OR: 9.40, p = 0.023) and chronic renal failure as defined by a glomerular filtration rate of less than 60 mL/min (OR: 6.42, p = 0.035).

Conclusions: Bradycardia is a frequent finding in patients undergoing ILR implantation due to un- explained syncope. Obesity, right bundle branch block and chronic renal failure are independent clinical predictors of pacemaker implantation 

Abstract

Background: Implantable loop recorders (ILR) are a valuable tool for the investigation of unexplained syncopal episodes. The aim of this retrospective single center study was to identify predictive factors for pacemaker implantation in patients with unexplained syncope who underwent ILR insertion.

Methods: One hundred six patients were retrospectively analyzed (mean age 59.1 years; 47.2% male) with unexplained syncope and negative conventional testing who underwent ILR implantation. The pri- mary study endpoint was detection of symptomatic or asymptomatic bradycardia requiring pacemaker implantation. 

Results: The average follow-up period after ILR implantation was 20 ± 15 months. Pacemaker im- plantation according to current guidelines was necessary in 22 (20.8%) patients, mean duration until index bradycardia was 81 ± 88 (2–350) days. Ten (45.5%) patients received a pacemaker due to sinus arrest, 7 (31.8%) patients due to third-degree atrioventricular block, 2 (9.1%) patients due to second- degree atrioventricular block and 1 (4.5%) patient due to atrial fibrillation with a slow ventricular rate. Three factors remained significant in multivariate analysis: obesity, which defined by a body mass index above 30 kg/m2 (OR: 7.39, p = 0.014), a right bundle branch block (OR: 9.40, p = 0.023) and chronic renal failure as defined by a glomerular filtration rate of less than 60 mL/min (OR: 6.42, p = 0.035).

Conclusions: Bradycardia is a frequent finding in patients undergoing ILR implantation due to un- explained syncope. Obesity, right bundle branch block and chronic renal failure are independent clinical predictors of pacemaker implantation 

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Keywords

implantable loop recorder; unexplained syncope; pacemaker

About this article
Title

Implantable loop recorders in patients with unexplained syncope: Clinical predictors of pacemaker implantation

Journal

Cardiology Journal

Issue

Vol 26, No 1 (2019)

Pages

36-46

Published online

2018-01-25

DOI

10.5603/CJ.a2018.0008

Pubmed

29399750

Bibliographic record

Cardiol J 2019;26(1):36-46.

Keywords

implantable loop recorder
unexplained syncope
pacemaker

Authors

Martin Huemer
Ann-Kristin Becker
Alexander Wutzler
Philipp Attanasio
Abdul S. Parwani
Philipp Lacour
Leif-Hendrik Boldt
Burkert Pieske
Wilhelm Haverkamp
Florian Blaschke

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