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Implantable loop recorder syncope

Christopher C Cheung, Andrew D Krahn
Implantable loop recorders (ILRs) have become an important pillar in the diagnostic work-up of patients with unexplained syncope. The modern ILR is minimally-invasive and provides an extended-duration of monitoring with high diagnostic yield. These insertable cardiac monitors (ICMs) enable prolonged monitoring that extends the opportunity for symptom-rhythm correlation from days-weeks to years, with associated incremental diagnostic yield. Over the years, observational studies and randomized trials have supported a unique role for ILRs in the assessment of recurrent or high-risk unexplained syncope...
October 3, 2016: Expert Review of Medical Devices
Rose Mary Ferreira Lisboa da Silva
The most frequent cause of syncope is vasovagal reflex. It is associated with worse quality of life, depression, fatigue and physical injury. Recurrence of vasovagal syncope is an aggravating, reaching the rate of 69%. Initial step and pharmacological treatment may not work, especially in patients with recurrent syncope without prodrome. These patients can present cardioinhibitory response with asystole. Studies were designed to analyses the effectiveness of pacemaker for prevention of syncope. In this review, nonrandomized clinical trials, open-label randomized, double-blind randomized, placebo-controlled, and studies based on tilt test or Implantable Loop Recorder findings will be discussed...
2016: Open Cardiovascular Medicine Journal
Michele Brignole, Regis Guieu, Marco Tomaino, Matteo Iori, Andrea Ungar, Cristina Bertolone, Matthias Unterhuber, Nicola Bottoni, Francesca Tesi, Jean Claude Deharo
BACKGROUND: "Unexplained syncope, no prodromes, and normal heart" has been described as a distinct clinical and biological entity. OBJECTIVE: The purpose of this study was to assess the mechanism of syncope. METHODS: In this prospective multicenter study, 58 patients presenting with unexplained syncope, no prodromes, and a normal heart received an implantable loop recorder (ILR) and were followed up until a diagnosis was established. Their outcomes were compared with those of 389 patients affected by reflex syncope with prodromes who received an ILR...
September 14, 2016: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Alessio Galli, Francesco Ambrosini, Federico Lombardi
Holter monitors are tools of proven efficacy in diagnosing and monitoring cardiac arrhythmias. Despite the fact their use is widely prescribed by general practitioners, little is known about their evolving role in the management of patients with cryptogenic stroke, paroxysmal atrial fibrillation, unexplained recurrent syncope and risk stratification in implantable cardioverter defibrillator or pacemaker candidates. New Holter monitoring technologies and loop recorders allow prolonged monitoring of heart rhythm for periods from a few days to several months, making it possible to detect infrequent arrhythmias in patients of all ages...
August 2016: Arrhythmia & Electrophysiology Review
Natale Daniele Brunetti, Pier Luigi Pellegrino, Girolamo D'Arienzo, Rafel Sai, Luigi Ziccardi, Francesco Santoro, Antonio Gaglione, Matteo Di Biase
We report the case of a 38-year-old woman with history of syncope and polymorphic ventricular tachycardia; tachycardia was inducible at exercise stress test, not at electrophysiologic study. Phases of QT prolongation were found at ambulatory electrocardiogram monitoring. The woman came to our attention for periodic control of implantable loop recorder. Rest electrocardiogram at admission unexpectedly showed sinus bradycardia, junctional rhythm, and ventricular premature beats. Furthermore, loop recorder control revealed a short run of bidirectional tachycardia, not associated with syncope...
July 28, 2016: Journal of Electrocardiology
Jennifer N Avari Silva, Burt I Bromberg, Fredrick K Emge, Tammy M Bowman, George F Van Hare
BACKGROUND: Implantable loop recorders (ILRs) are conventionally utilized to elucidate the mechanism of atypical syncope. The objective of this study was to assess the impact of these devices on management of pediatric patients with known or suspected inherited arrhythmia syndromes. METHODS AND RESULTS: A retrospective chart review was undertaken of all pediatric patients with known or suspected inherited arrhythmia syndromes in whom an ILR was implanted from 2008 to 2015...
June 2016: Journal of the American Heart Association
Masato Fukunaga, Dan Wichterle, Petr Peichl, Bashar Aldhoon, Robert Čihák, Josef Kautzner
AIMS: In patients with severe neurally mediated syncope (NMS), radiofrequency catheter ablation (RFA) of ganglionic plexi (GP) has been proposed as a new therapeutic approach. Cardio-inhibitory response during NMS is usually related to the sinoatrial (SA) and less frequently to atrioventricular (AV) node. Differential effect of GP ablation on SA and AV node is poorly understood. METHODS AND RESULTS: We report a case of a 35-year-old female with frequent symptomatic episodes of advanced AV block treated by anatomically guided RFA at empirical sites of GPs...
May 18, 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Ritsuko Kohno, Haruhiko Abe, Naoki Akamatsu, David G Benditt
BACKGROUND: Ictal asystole (IA) is an infrequent complication of temporal lobe epilepsy (TLE), but one that may cause transient loss of consciousness (T-LOC) similar to reflex syncope (particularly the vasovagal faint). Although IA-triggered T-LOC is relatively rare, its recognition is therapeutically important. However, while the need for anti-epileptic drugs (AeDs) is broadly accepted, cardiac pacing in IA is controversial. This study aimed to evaluate the need for cardiac pacing in the follow-up of IA patients being treated with AeDs...
August 2016: Journal of Cardiovascular Electrophysiology
Monica Solbiati, Giorgio Costantino, Giovanni Casazza, Franca Dipaola, Andrea Galli, Raffaello Furlan, Nicola Montano, Robert Sheldon
BACKGROUND: The most recent syncope guideline recommends that implantable loop recorders (ILRs) are implanted in the early phase of evaluation of people with recurrent syncope of uncertain origin in the absence of high-risk criteria, and in high-risk patients after a negative evaluation. Observational and case-control studies have shown that loop recorders lead to earlier diagnosis and reduce the rate of unexplained syncopes, justifying their use in clinical practice. However, only randomised clinical trials with an emphasis on a primary outcome of specific ILR-guided diagnosis and therapy, rather than simply electrocardiogram (ECG) diagnosis, might change clinical practice...
2016: Cochrane Database of Systematic Reviews
Silvia Placidi, Fabrizio Drago, Maddalena Milioni, Letizia Verticelli, Ilaria Tamburri, Massimo Stefano Silvetti, Corrado DI Mambro, Daniela Righi, Fabrizio Gimigliano, Mario Salvatore Russo, Rosalinda Palmieri, Romolo Remoli, Lorenzo Maria Santucci, Alberto Eugenio Tozzi
BACKGROUND: The etiological diagnosis of syncope and/or palpitations in children is often challenging. However, when noninvasive conventional examinations are inconclusive, the subcutaneous miniaturized implantable loop recorder (ILR) is recommended. The aim of our study was to evaluate the efficacy of miniaturized cardiac implantable devices in the early diagnosis of arrhythmias in children ≤6 years. METHODS: From March 2014 to May 2015, 21 patients (median age 5 years) underwent implantation of miniaturized ILR at our Institution after a complete cardiac work up...
July 2016: Pacing and Clinical Electrophysiology: PACE
Nicholay Teodorovich, Moshe Swissa
A tilt table test (TTT) is an inexpensive, noninvasive tool for the differential diagnosis of syncope and orthostatic intolerance and has good diagnostic yield. The autonomic system malfunction which underlines the reflex syncope is manifested as either hypotension or bradycardia, while an orthostatic challenge is applied. The timing of the response to the orthostatic challenge, as well as the predominant component of the response help to differentiate between various forms of neurocardiogenic syncope, orthostatic hypotension and non-cardiovascular conditions (e...
March 26, 2016: World Journal of Cardiology
Jaspreet Bhangu, C Geraldine McMahon, Patricia Hall, Kathleen Bennett, Ciara Rice, Peter Crean, Richard Sutton, Rose-Anne Kenny
AIMS: Unexplained falls account for 20% of falls in older cohorts. The role of the implantable loop recorder (ILR) in the detection of arrhythmias in patients with unexplained falls is unknown. We aimed to examine the diagnostic utility of the ILR in detection of arrhythmogenic causes of unexplained falls in older patients. METHODS: A single centre, prospective, observational cohort study of recurrent fallers over the age of 50 years with two or more unexplained falls presenting to an emergency department...
May 2016: Heart: Official Journal of the British Cardiac Society
Florian Blaschke, Philipp Lacour, Thula Walter, Alexander Wutzler, Martin Huemer, Abdul Parwani, Philipp Attanasio, Leif-Hendrik Boldt, Marcus Markowski, Timm Denecke, Wilhelm Haverkamp
BACKGROUND: Implantable loop recorders (ILRs) allow continuous cardiac monitoring for 3-6 years and are a valuable tool for the investigation of syncopal episodes, palpitations, and atrial fibrillations as well as risk stratification after myocardial infarction. Although magnetic resonance imaging (MRI) in patients with ILRs has been shown to be safe, the impact of ILRs on cardiac MRI image quality has not been investigated yet. Thus, we tested the diagnostic value of cardiac MRI in patients with various types of ILRs...
May 2016: Annals of Noninvasive Electrocardiology
Arjun Rash, Maureen McRae, Jaleh Fatehi, Deborah Richie, Monica Solbiati, Neelan Pillay, Annegret Ulke-Lemée, Justin MacDonald, Robert Sheldon
BACKGROUND: The diagnosis of vasovagal syncope continues to be difficult despite the use of accurate histories, tilt testing and implantable loop recorders. A circulating biomarker might be useful to facilitate diagnoses. Both endothelin-1 and vasopressin are increased during positive tilt tests resulting in syncope. Copeptin is a stable cleavage product of vasopressin formation. We conducted a pilot study to assess the utility of endothelin-1 and copeptin as circulating biomarkers of vasovagal syncope...
February 2016: European Journal of Clinical Investigation
Michele Brignole, Francesco Arabia, Fabrizio Ammirati, Marco Tomaino, Fabio Quartieri, Martina Rafanelli, Attilio Del Rosso, Maria Rita Vecchi, Vitantonio Russo, Germano Gaggioli
AIMS: The aim of this study was to determine the long-term effects and determinants of success of cardiac pacing in patients affected by reflex syncope enrolled in the Syncope Unit Project 2 (SUP 2) study. Initial results have validated the effectiveness of a standardized guideline-based algorithm which can be used in clinical practice in order to select suitable candidates for cardiac pacing. METHODS AND RESULTS: In this prospective, multicentre, observational study, patients aged >40 years, affected by severe unpredictable recurrent reflex syncope, underwent carotid sinus massage (CSM), followed by tilt testing (TT) if CSM was negative, followed by implantation of an implantable loop recorder (ILR) if TT was negative...
September 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Neil Sulke, Conn Sugihara, Paul Hong, Nik Patel, Nick Freemantle
AIMS: This prospective randomized controlled study evaluated the first-line use of a novel remotely monitored implantable loop recorder (ILR) in the initial investigation of unexplained syncope, and compared this to conventional therapy and a dedicated Syncope Clinic (SC). METHODS AND RESULTS: A total of 246 patients (mean age 70.3 years) were randomly allocated to conventional management, SC alone, ILR alone, or SC + ILR. Median follow-up was 20 months (IQR 15-25 months)...
June 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Antonio Frontera, Alexander Carpenter, Nauman Ahmed, Matteo Fasiolo, Martin Nelson, Ihab Diab, Tim Cripps, Glyn Thomas, Edward Duncan
BACKGROUND: There is growing interest in detecting paroxysmal atrial fibrillation (PAF) to identify patients at high risk of thromboembolic stroke. The implantable loop recorder (ILR) is emerging as a powerful new tool in the diagnosis of PAF. Widespread implantation has significant cost implications and their use must be targeted at those patients at most risk. METHODS: We retrospectively studied a population of 200 adult patients who underwent ILR implantation for the investigation of syncope or palpitations...
October 2015: Pacing and Clinical Electrophysiology: PACE
Robert Sheldon
Convulsive syncope is a common cause of misdiagnosis in patients who present with a transient loss of consciousness. This misdiagnosis contributes significantly to the numbers of patients with a questionable diagnosis of epilepsy, and to those with apparently drug-resistant epilepsy. The most important step to an accurate diagnosis is a fastidious history. Inducing syncope with tilt table testing and documenting heart rate changes during events with implantable loop recorders have proved to be useful. These suggest the need for closer and ongoing collaboration among neurologists and cardiologists to provide optimal care for patients with the diagnostic dilemma of syncope or epileptic seizures...
August 2015: Cardiology Clinics
Mark Preminger, Suneet Mittal
With the advent of implantable loop recorders capable of prolonged electrocardiographic monitoring, and following studies demonstrating the benefit of implantable cardioverter-defibrillator therapy in subgroups of patients with structural heart disease and depressed left ventricular function, the role of invasive cardiac electrophysiologic (EP) studies in patients with unexplained syncope has been substantially reduced. Nonetheless, in select high-risk patients presenting with unexplained syncope, EP studies still play an important role in identifying a diagnosis in these patients and assessing long-term risk of mortality...
August 2015: Cardiology Clinics
Franco Giada, Angelo Bartoletti
Implantable loop recorders (ILRs) continuously monitor electrocardiographic signals and perform real-time analysis of heart rhythm for up to 36 months. ILRs are used to evaluate transitory loss of consciousness from possible arrhythmic origin, particularly unexplained syncope, and to evaluate difficult cases of epilepsy and unexplained falls, although current indications for their application in these areas are less clearly defined. This article analyzes the current indications for ILRs according the European Society of Cardiology guidelines on the management of syncope and the European Heart Rhythm Association guidelines on the use of implantable and external electrocardiogram loop recorders, and their limitations...
August 2015: Cardiology Clinics
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