[Usefulness of the implantable subcutaneous recorder in the diagnosis of recurrent syncope of unknown etiology in patients without structural heart disease and negative tilt test and electrophysiological study]

[Atypical sinus node dysfunction. Usefulness of implantable Holter. A case report]

We present an 84 year-old female patient with repeated syncopes/presyncopes in the last nine years. All diagnosis tests were negative, including ECG, 24-hour Holter, tilt table test and EP study. Therefore, a subcutaneous insertable loop recorder was implanted (Reveal). The recording of three episodes showed the association of presyncope with the onset of atrial fibrilation and, in two syncopes, with an atrial pause between AF episodes. Probably an abnormal prolonged sinus node recovery time (more than 6 s) allowed AF to restart before the sinus rhythm.