Vol 66, No 1 (2008)
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Published online: 2008-02-04

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Original article
High incidence of tachyarrhythmias detected by an implantable loop recorder in patients with unexplained syncope

Christiana Schernthaner, Franz Danmayr, Johann Altenberger, Maximilian Pichler, Bernhard Strohmer
DOI: 10.33963/v.kp.80757
Kardiol Pol 2008;66(1):37-44.

Abstract


Background:

Syncope is a complex clinical syndrome that may be challenging with respect to a definite diagnosis. The implantable loop recorder (ILR) is a useful tool to define but also to exclude an arrhythmic aetiology.
Aim:

To investigate the causes of recurrent syncope or near-syncope with respect to underlying arrhythmias in non-selected consecutive patients monitored with an ILR.
Methods:

A retrospective study was conducted including 55 patients (34 men, 21 women; age 60±19 years) with unexplained syncope who received an ILR for prolonged monitoring at our institution between April 1998 and October 2006.
Results:

Forty (73%) patients had a recurrence of syncope or near-syncope. Structural heart disease was present in 18 (33%) patients, 4 of them having an ejection fraction <35%. An arrhythmia was detected as the cause of syncope in 25 (46%) patients. The ILR was successful in establishing a symptom-rhythm correlation in 63%. The mean follow-up period from implantation to occurrence of the detected arrhythmias was 9±8 months. Bradyarrhythmias were recorded in 12 (22%) patients, whereas tachyarrhythmias were found in 13 (24%) patients. Narrow QRS tachycardia was the underlying arrhythmia in 6 patients and wide QRS tachycardia in 7 patients. A pacemaker was implanted in all 12 patients with bradyarrhythmias. Implantable cardioverter defibrillator (ICD) therapy was indicated in 6 patients with adjunctive catheter ablation in 3 of them. Four patients presenting with paroxysmal supraventricular tachycardia were treated with radiofrequency catheter ablation.
Conclusion:

The ILR helped efficaciously to determine the correct diagnosis and appropriate treatment of recurrent syncope. A considerably high proportion of tachyarrhythmias was detected in this non-selected consecutive population. The majority of patients with tachyarrhythmic syncope required defibrillator implantation and/or radiofrequency ablation.

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Polish Heart Journal (Kardiologia Polska)