CARDIAC ARRHYTHMIAS AND UNDETERMINATE SYNCOPE. DIAGNOSTIC USEFULNESS OF IMPLANTABLE LOOP RECORDER (ILR) 

Pettinati G., Melissano D., De Santis F.,

Division of Cardiology – “F. Ferrari” Hospital - Casarano (Italy)

Mediterranean Journal Pacing and Electrophysiology.

Volume 9 n. 1  January - March 2007

Many non invasive tests (ECG, Holter, Tilt Test, Ecodoppler, etc.) for the diagnostic assessment of syncope are performed, however 30% of the syncope is unexplained. ILR (Medtronic Reveal) is actually a important device for the evaluation of patients with recurrent indeterminate syncope.

Aim of the study

Was to assess the incidence of ipokinetic and iperkinetic arrhythmias on the population affected by syncope of unknown origin by ILR.

Material and method

We implanted from 1999 to 2007 30 patients, 18 F. 12 M., mean age 58 +/- 12 (range 20 – 74 y.), with recurrent unexplained syncopal episodes > 3/years and very often studied by many and expensive non invasive investigations. We implanted ILR reveal 95/25 and 95/26 Medtronic in the left subclavear site using local anaesthetic.

Results

During a follow – up of 6 +/- 5 months (range 1 – 12 months) 25/30 patients (83%) presented syncopal episodes and 15/25 (60%) has cardiac arrhythmias immediately before and during the syncope. Out 15 arrhythmias patients 10/15 (67%) presented brady-arrhythmias (7 parossistic atrio-ventricular block, 3 Sick Sinus syndrome) 5/15 (33%) presented tachy-arrhythmias (2 supraventricular-tachycardia, 3 rapid atrial fibrillation). 5/30 (17%) patients during follow-up not presented syncope. All arrhythmia patients by pharmacological and electrical therapy are asymptomatic.

Conclusion

Our study demonstrated that greater cause (60%)  of unexplained syncope is cardiac arrhythmias and the ILR is useful diagnostic tool to determinate a cause of recurrent syncope